COVID-19 UPDATE #135
February 9, 2021
THIRD CLINIC VACCINE POLICY
The CDC’s Long Term Care Pharmacy Partnership Program provides three COVID-19 vaccination clinics for long term care facilities enrolled in the program. As many facilities are closing in on their third clinic, questions have arisen whether residents and staff will be able to receive a first dose of the vaccine at the third and final clinic. The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) has been actively working with CDC, CVS, and Walgreens on this issue. 
CDC policy is to optimize vaccine access for residents and staff, which means delivering the first dose of either vaccine at the third clinic. However, the pharmacies will defer to state/jurisdictional guidance. According to Kathy Bay at the Department of Health, Washington State supports first vaccinations given at the third clinic for residents and staff. This information has been shared with Walgreens and CVS. Please have a discussion with your pharmacy partner regarding this practice, and contact Kathy Bay with any questions.
If residents and staff receive the first dose of the vaccine at the third clinic, it is important to determine how they will access the second dose. For assistance in securing the second dose on behalf of staff or residents, providers should: 
  • Contact Washington State Department of Health for more information on vaccine availability. 
  • Call one of the retail pharmacies involved in the CDC’s Federal Retail Pharmacy Program. Retail pharmacies participating in the program vary by state and territory; visit the CDC website to find out which pharmacies are participating in Washington. 

If your facility received the Pfizer-BioNTech vaccine through the Pharmacy Partnership, it may be more challenging to access a second dose due to the unique cold chain storage requirements. If all potential options for administering the second dose have been exhausted, clinical leadership may consider the following:  
  • Counseling residents to finish the vaccine series using the Moderna vaccine. The Advisory Committee on Immunization Practices recommends
  • ​“In exceptional situations in which the first-dose vaccine product cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimum interval of 28 days between doses to complete the mRNA COVID-19 vaccination series.” ​ 

Delay timing of the second dose administration up to six weeks (42) days. CDC guidance dictates that in situations where it is not feasible to adhere to the recommended interval (21 days for Pfizer and 28 days for Moderna), the second dose can be administered up to six weeks (42 days) after the first. Click here for FAQs on third clinics. Read more.
STANDING ORDERS FOR PFIZER AND MODERNA
Under state law, nurses and MAs may administer vaccines only under the prescription of certain kinds of prescribers, which do not include pharmacists. These standing orders will give nurses and MAs the legal authority they need to assist pharmacies with their vaccination efforts. 

Providers will need to abide by their normal standards of practice and governing laws in operating under these standing orders. These standing orders will not permit administration of a vaccine if any contraindication or precaution is identified during screening. Anybody with those conditions would need to obtain a personalized consultation from a qualified health care provider.

Standing Orders
CMS ALERT ON MEDICARE FRAUD
Last week, CMS released an email update focused on Medicare fraud. The email states that “as the country begins to distribute COVID-19 vaccines, scammers are taking advantage of the coronavirus pandemic. The HHS Office of Inspector General alerted the public about COVID-19 fraud schemes, with scammers using telemarketing calls, text messages, social media platforms, and door-to-door visits to perpetrate COVID-19-related scams. Con artists may also try to get Medicare Numbers or personal information so they can steal identities and commit Medicare fraud. Medicare fraud results in higher health care costs and taxes for everyone.”  

The email noted the following important information and tips for Medicare beneficiaries to help prevent them from becoming victims of fraud:  
 
WASHINGTON CENTER FOR NURSING SEEKS FEEDBACK ON IMPACTS OF COVID-19 ON NURSING WORKFORCE
The Washington Center for Nursing is collecting data on the impact of COVID-19 on the nursing workforce. Click here for an informational flyer you can read and share. The data collection involves two methods, a survey and focus groups. They are seeking participants for their February focus groups. They seek nursing students and nurses across licensures (e.g., CNA, LPN, RN, ARNP) to participate in their online focus group via Zoom.

Interested persons are asked to complete a few screening questions and an informed consent here. If selected to participate, you will receive a $20 Amazon e-gift card at the end of the focus group session that lasts 60-90 minutes. 
FEDERAL RETAIL PHARMACY PROGRAM LAUNCHES FEBRUARY 11
Beginning on February 11, eligible individuals will have the opportunity to receive a COVID-19 vaccine at select pharmacies across the country through the Federal Retail Pharmacy Program. This program is a public-private partnership with 21 national pharmacy partners and networks of independent pharmacies, many of which include long term care pharmacies.  
This will be an important option to ensure new staff and residents have continued access to the COVID-19 vaccine after completion of the Pharmacy Partnership. Long term care pharmacies enrolled in the Federal Retail Pharmacy Program can order the vaccine directly from the federal government. CDC will provide more detailed guidance in the coming weeks on next steps for COVID-19 vaccination in LTCFs after the Federal Pharmacy Partnership for LTC Program concludes.
BEHAVIORAL HEALTH WEBINAR SERIES FOCUSES ON COVID-19 RESOURCES
The Behavioral Health webinar series will include Resources to Support Behavioral Health Needs of Patients During COVID-19 on February 24, 2021, from 12:00 noon to 1:00 PM. The webinar will highlight consultation resources that hospitals can utilize to support the behavioral health needs of patients, particularly in light of growing behavioral health impacts related to COVID-19. Speakers from the University of Washington’s (UW) Psychiatry Consultation Line (PCL), Seattle Children’s Partnership Access Line (PAL for Kids), and the UW Perinatal Psychiatry Consultation Line (PAL for Moms) will discuss multiple resources to support providers and hospitals to meet the behavioral health needs of patients. The Washington State Hospital Association encourages primary care practices and nursing homes to participate in this webinar. Click here to register.
CONGRESS ENACTS CHANGES TO EMPLOYEE RETENTION CREDIT
Congress recently enacted changes to the employee retention credit that was first created by the CARES Act as a means to help certain employers impacted by the pandemic. AHCA/NCAL recommends discussing this with your tax professionals to gauge their potential usefulness for your business. 

This redline version of the legislative text shows the statutory changes recently made to the employee retention credit. Additional information is provided in this KPMG update.
ORGANIZATIONS CALL ON CMS TO EASE MEDICARE ENROLLMENT DURING THE COVID-19 PANDEMIC
Last week, the Medicare Rights Center and 49 state and national organizations, including AHCA/NCAL, urged CMS to reinstate two policies to help people sign up for Medicare amid the COVID-19 pandemic:  
  • ​A Special Enrollment Period (SEP) for Part C and Part D 
  • Equitable Relief for Premium Part A and Part B 
 
CMS established these enrollment pathways last May, promoting access to coverage and care during the COVID-19 public health crisis. However, the enrollment flexibilities were allowed to lapse shortly thereafter, despite clear and ongoing needs. 
 
In the letter, the organizations ask CMS to help by renewing and strengthening the SEP and Equitable Relief flexibilities. The letter includes that these policies should remain in effect through the calendar year in which the emergency period ends, at a minimum, and coverage should begin as soon as possible—no later than the first day of the month following enrollment. You can read the full letter here, and the Medicare Rights Center’s press statement.
LTC TREND TRACKER LAUNCHES COVID-19 DASHBOARD FOR ALL USERS
The COVID-19 pandemic has had a profound impact on the nursing home industry with more than 40 percent of deaths associated with nursing homes. This effort is an online web resource that AHCA/NCAL members can access to find important data related to COVID, their buildings, and the community. Click here to learn more about key features.
WA-PALTC OFFERING WEBINAR ON MONOCLONAL ANTIBODIES TREATMENT
The Washington Society for Post-Acute and Long Term Care Medicine (WA-PALTC) is hosting Monoclonal Antibodies Treatment for COVID in the Long Term Care Setting via webinar on Thursday, February 11, 2021, at 6:00 PM. The panelists on the webinar will discuss the latest evidence and how it can be delivered safely to patients. Click here to register.
ADDITIONAL RESOURCES
WHCA continues to post resources and information as it becomes available on our website. If you have questions or need additional information, please call the WHCA office at (800) 562-6170.