COVID-19 Updates: March 24, 2020
This update includes:
- Governor Evers' "Safer-At-Home" Order Takes Effect Wednesday 3/25 at 8 a.m.
- CMS Announces New Targeted Plan for Surveys
- Action Requested: Strategic National Stockpile Order Process -- THIS ORDER NEEDS TO BE COMPLETED BY 4:30 P.M. ON WEDNESDAY, 3/25
- Cost Reporting Website Available
- Workforce Resources for Long-Term Care Providers
- DHS COVID-19 Long-Term Care Meeting, 3.24.20
- Division of Medicaid Services Meeting, 3.24.20
- CMS Announces SNF QRP and VBP Relief in Response to COVID-19
- Conversations Revisiting End-of-Life Wishes and Advance Directives
- Preparing for States' Use of Increased FMAP Funds
- Public Call for Supplies
As of today, there are 457 confirmed cases of COVID-19 in the state of Wisconsin and five deaths caused by the virus. Of the 8,694 tests in Wisconsin, 8,237 have come back negative. Click
to view the latest outbreak information from the Wisconsin Department of Health Services.
County 'Lockdown' Orders Need Clarification
WHCA/WiCAL continues to express significant concern about so-called “lockdown” orders by county and municipal health departments. So far Ozaukee, Washington, Racine, and Jefferson Counties, as well as the City of Appleton are the localities known to have each issued similar orders requiring the constant use of PPE among staff without providing any consideration of the limited supply of PPE that is available. Given the shortage of available PPE, and the conflicting orders between local, state and federal governments, members are encouraged to exercise their best judgment in the use of available PPE, in accordance with CDC, CMS, and DHS guidelines.
Facilities located in areas where these orders have or will be put into effect are encouraged to contact their local public health departments to express their concerns about the effects that these orders have on the availability of PPE. During the briefing call with LTC stakeholders on Tuesday afternoon, Jeanne Ayers, Administrator of the DHS-Division of Public Health said that local public health can issue more restrictive guidance than the state does, and those orders are within their authority. WHCA/WiCAL has requested Ayers to ask local health departments to qualify these recommendations, and facilitate the coordination of more clear communication between state and county officials.
Governor Evers' "Safer-At-Home" Order Takes Effect Wednesday 3/25 at 8 a.m.
Today, Governor Evers issued an
that will require people to mostly stay at home except for essential travel, like buying groceries, visiting the doctor, picking up medicine, or caring for others. (Please note, the above order includes highlighted provisions specific to LTC).
The order will take effect at 8:00 a.m. on Wednesday, March 25, 2020 and will remain in effect until 8:00 a.m. on Friday, April 24, 2020.
Healthcare operations, banks, child care facilities, grocery stores, and other essential businesses will be allowed to operate.
According to Governor Evers, without the "Safer-At-Home" order, there will be 20,000 positive COVID-19 cases in Wisconsin and 1,000 deaths within two weeks.
to view more information on how the "Safer-At-Home" order will affect long-term care providers.
CMS: Prioritization of Survey Activities
Late yesterday, CMS released
suspending most federal and state survey agency (SSA) surveys, and delaying revisit surveys, for the next three weeks beginning on March 20, 2020, for all nursing homes. For non-IJ related onsite surveys that are currently in process, survey teams are instructed to end the survey and exit the facility.
State and federal surveyors should not enter the building, for any type of survey, if they are unable to meet the Personal Protective Equipment (PPE) expectations outlined by the latest CDC guidance. They may instead obtain necessary information remotely, to the extent possible.
WHCA/WiCAL has reached out to DQA for clarification if this means that facilities can turn surveyors away if they do not provide their own proper PPE.
Federal and state surveyors will conduct targeted infection control surveys of providers identified together with the Centers for Disease Control and Prevention (CDC) and the HHS Assistant Secretary for Preparedness and Response (ASPR). They will use this
focused survey tool
to review infection prevention and control practices. Surveyors will review for:
- Overall effectiveness of the Infection Prevention and Control Program (IPCP) including policies and procedures
- Standard and Transmission-Based Precautions (with the understanding that certain essential supplies are scarce, and facilities should not be penalized for not having certain supplies if they are unable to obtain them)
- Quality of resident care practices, including those with COVID-19 (laboratory-positive case), if applicable
- Surveillance plan
- Visitor entry and facility screening practices
- Education, monitoring and screening practices of staff
- Facility policies and procedures to address staffing issues during emergencies, such as transmission of COVID-19
WHCA/WiCAL recommends facilities use the above linked focused survey tool to ensure compliance during the COVID-19 outbreak.
Changes in the survey process in effect for the next three weeks include:
- Standard surveys and non-IJ revisits are suspended for three weeks
- During this period, the following surveys will be suspended:
- Standard surveys for nursing homes, hospitals, home health agencies (HHAs), intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and hospices.
- Life safety code and emergency preparedness elements of standard surveys.
- Revisits not associated with an IJ.
- The following enforcement actions will be suspended, until revisits are again authorized:
- Imposition of Denial of Payment for New Admissions (DPNA), including situations where facilities are not in substantial compliance at 3 months.
- Imposition of termination for facilities that are not in substantial compliance at 6 months.
- Per day civil money penalties (CMP) will not accumulate.
- CMS will not impose any new remedies for prior noncompliance.
- Note: Enforcement actions for unremoved or new IJs remain and will continue to be issued under normal procedures/guidance.
- Complaints and facility-reported incidents triaged at the Immediate Jeopardy level will continue
- During this three-week time frame, State survey agencies (SSAs) and CMS will only conduct surveys related to complaints and facility-reported incidents (FRIs) that are triaged at the Immediate Jeopardy (IJ) level, and revisits to verify removal of IJ (including previously cited IJ deficiencies).
- If the revisit survey determines there is continuing noncompliance, but at a lower level than IJ, surveyors will not conduct another onsite revisit survey.
- For non-IJ deficiencies, providers may submit a plan of correction (POC) to be held until the end of the three-week period or may delay submission of their POC until the end of this period.
- Enforcement actions for unremoved or new IJs remain and will continue to be issued under normal procedures/guidance.
- Perform self-assessments on infection control using surveyor tool
- Use the COVID-19 Infection Control Focused Survey tool contained in the CMS memo (developed with CDC) to perform self-assessment of your facility’s Infection Control plan. This document may be requested by surveyors, if an onsite investigation takes place.
- CDC recommends that nursing homes notify their health department about residents with severe respiratory infection, or a cluster of respiratory illness (3 or more residents or HCP with new-onset respiratory symptoms within 72 hours).
- Note: Local and state reporting guidelines or requirements may vary.
Action Requested: Strategic National Stockpile Order Process
The State Emergency Operations Center has notified Wisconsin Department of Health Services that a limited supply of personal protective equipment (PPE) from the Strategic National Stockpile (SNS) is available for distribution.
These supplies include N95 respirators, surgical masks, face shields, hoods, gowns, coveralls, and gloves.
The following groups are eligible to receive PPE resources from the SNS supply:
- Long term care
- In-home personal care agencies
- Emergency Medical Services (EMS)
Facilities/agencies that submit requests must meet all of the following criteria:
- 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, and
- Facility/agency has consistently implemented CDC strategies to optimize use of N95 respirators.
Additionally, in order to be eligible, hospitals must complete the COVID-19 Essential Elements of Information daily in EMResource.
DHS will use a Scarce Resource Decision Tree to determine to which agencies PPE will be allocated.
Please use this link to order PPE from the SNS:
THIS ORDER NEEDS TO BE COMPLETED BY 4:30 P.M. ON WEDNESDAY, 3/25.
These items are past their manufacturer-designated shelf life. They may not be used in surgical settings. FDA has provided an emergency use authorization that allows these resources to be used for this purpose. Due to scarcity of resources, you will not receive your full order.
Cost Reporting Website Available
When the University of Wisconsin closed the Center for Health Systems Research Analysis (CHSRA) in June 2019, nursing home rate-setting work transitioned to an LLC formed by former employees called Forward Data Analytic Services, LLC and the online cost reporting platform "ORBS" was temporarily shut down. "ORBS" is now back at a new url:
If you are a former user of the platform, please use the "Forgot my password" link to set a new password. Old passwords have not transitioned to the new platform for security purposes, although user accounts have. If you have forgotten your username there is also a link for that.
If you are a submitter of cost reports for a facility that did not have an account on the old platform, you may register for a new account.
Finally, the website has a new "Help" email address:
. Please include your first and last name, contact phone number, email address, nursing facility name and POPID (or, if applicable, Accounting Organization or Chain affiliation) when contacting
Many facilities have submitted 2019 cost reports via email to their regional auditor during the period where "ORBS" was shut down. No action is required by these facilities at this time. Facilities with a calendar year end who have not yet submitted a 2019 cost report should submit via
the new platform
. All 2019 cost report submissions are due May 31.
Workforce Resources for Long-Term Care Providers
DHS COVID-19 Long-Term Care Meeting, 3.24.20
Earlier today, the Department of Health Services-Division of Quality Assurance held a webinar to answer questions from long-term care providers about the following subjects:
- Nursing Home/Assisted Living Discharge
- Personal Protective Equipment (PPE)/Local Public Health
- Family Care/Medicaid
Read the highlights from the meeting
Division of Medicaid Services Meeting, 3.24.20
The Division of Medicaid Services held a virtual meeting Tuesday afternoon providing stakeholders with updates from the Department of Health Services. This meeting is standing on Tuesday and Thursday afternoons for as long as they are needed.
Betsy Genz, Director of the Bureau of Adult Programs and Policy, has compiled an extensive FAQ for MCOs related to current policy that will be shared with the public soon. Genz also indicated DHS is working on completing an 1135 waiver request that they hope to get submitted to CMS very soon. They anticipate CMS will approve the waiver shortly thereafter. No details were provided about the contents of the waiver request.
Kiva Graves, Director of the Bureau of Adult Quality and Oversight shared that they have asked MCOs to refrain from contacting SNFs and ALs about routine issues. They realize providers are extremely busy right now ensuring the health and safety of their residents and have instructed MCOs to let providers know they are available if needed but no to routinely contact them during this time.
Lastly, Graves briefly discussed Governor Evers’ Safer At Home order that goes into effect tomorrow. She said they do not anticipate law enforcement requiring proof from employees at this time and as such are not working on guidance for long-term care workers. They will update their stance on this as needed.
CMS Announces SNF QRP and VBP Relief in Response to COVID-19
On March 22, the Centers for Medicare & Medicaid Services (CMS)
administrative burden relief for providers participating in various quality programs during the COVID-19 outbreak. CMS recognizes that quality measure data collection and reporting for services furnished during this time of emergency may not be reflective of their true level of performance on measures such as cost and readmissions and seeks to hold organizations harmless for not submitting data during this period. Specific to SNFs, CMS is implementing exceptions and extensions for upcoming measure reporting and data submission deadlines for:
Skilled Nursing Facility Quality Reporting Program
- 2019 Data Submission: April/May deadlines for October 1, 2019 – December 31, 2019 (Q4) data submission is now optional. If Q4 is submitted, it will be used to calculate the 2019 performance and payment (where appropriate).
- 2020 Data Submission: Data from January 1, 2020 through June 30, 2020 (Q1-Q2) does not need to be submitted to CMS for purposes of complying with SNF QRP requirements.
- 2020 Claims-based measures: No data reflecting services provided January 1, 2020 through June 30, 2020 will be used in CMS’s calculations.
Skilled Nursing Facility Value-Based Purchasing (VBP) Program
- Qualifying claims will be excluded from the claims-based SNF 30-Day All-Cause Readmission Measure (SNFRM; NQF #2510) calculation for Q1-Q2.
CMS will continue monitoring the developing COVID-19 situation and assess options to bring additional relief to providers so they can focus on caring for patients.
Conversations Revisiting End-of-Life Wishes and Advance Directives
In light of the high mortality rate (20-30%) for nursing home and assisted living community residents who become infected with COVID-19, AHCA/NCAL urges you to:
- Have conversations with residents and families about their end-of-life wishes now before someone becomes ill.
- Ensure residents’ advance directives, Provider Orders for Life-Sustaining Treatment (POLST), and other documents are all up to date with current documented wishes, and physician orders are consistent with these wishes.
In the coming weeks, we expect to have hospital surges across the country that will exceed the capacity to transfer nursing homes and assisted living communities' residents with suspected or confirmed COVID-19. Discussing with residents and families now as to how they want to be cared for in place in the nursing home or assisted living community will be helpful to inform how to best meet their wishes, in advance of the anticipated continued spread of COVID-19, and its increased strain on the health care system.
Preparing for States' Use of Increased FMAP Funds
Due to significant increases in unemployment from business closures and related furloughs, states may choose to use any portion of last week’s 6.2% increase in federal Medicaid payments to provide Medicaid coverage for the newly unemployed and, very likely, uninsured. Such decisions will result in less Medicaid funding for provider rate increases to cover COVID-related costs.
However, on March 21, the federal government announced that it is considering a special enrollment period for Affordable Care Act Health Insurance Exchange (HIX) coverage. Individuals purchase health care coverage through the HIX. The special enrollment period would be aimed at offering lower cost coverage to the individuals with reduced incomes if made available. Such a special enrollment period might influence state decision making on how much of the 6.2% federal Medicaid funding should be used on coverage versus COVID-related provider expenses.
WHCA/WiCAL is working with the state on a decision on how to divide funds between Medicaid coverage for the uninsured and provider rate increased to address new COVID-related costs.
PPE supplies are running dangerously low in most long-term care facilities. Many facilities and states are issuing calls for public donations. AHCA/NCAL has developed a
to serve as a call for donations.
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.