COVID-19 UPDATE #137
February 18, 2021
REPAYMENT FOR SNF MEDICARE ADVANCE AND ACCELERATED LOANS BEGINS SOON
Last year Congress passed the Medicare Advance and Accelerated Payments Program (AAP). Congress has not included a repayment extension or loan forgiveness for the AAP. However, AHCA’s Government Relations team was successful in securing SNF access to the now significantly extended repayment window and a fixed interest rate of 4% which was enacted in December 2020. Without inclusion in this legislation, SNFs would have had to repay the AAPs in six months and been subject to whatever the Treasury Department’s interest rate was when CMS begins collection. While not ideal, these are significant improvements over what would have been a much more challenging scenario. For additional information on AAP repayment schedules and repayment options click here.
FEDERAL COURTS ADDRESS IMMUNITY FROM LIABILITY
We wanted to pass on information received from Argentum regarding recent developments in courts providing liability protections. On February 10, 2021, a California federal court ruled that measures taken by a senior living community in response to COVID-19 are eligible for complete liability immunity under the PREP Act. 

In Gilbert Garcia et al v. Welltower OpCo Group LLC, Sunrise Senior Living Management, Inc., et al, Case No. SACV 20-02250JVS(KESx), U.S. District Court, Central District of California, the Court granted defendants' motion to dismiss plaintiffs' claims of elder abuse and neglect, wrongful death and intentional infliction of emotional distress for alleged failure "to implement appropriate infection control measures or follow local or public health guidelines in preparing for and preventing COVID-19 spread" at their assisted living property.

At this juncture we would caution you that federal district court decisions have no precedential value, especially if the court in question is located in a different state. Nonetheless, these developments are encouraging and we will continue to keep you informed. Should you have questions please email WHCA CEO Robin Dale.
DEAR ADMINISTRATOR LETTER PROVIDES INSIGHT ON COMPASSIONATE CARE VISITS AND ESSENTIAL SUPPORT PERSONS
In a Dear Administrator letter dated February 10, 2021, all providers are given links to two one-page resources about compassionate care visits and another one on essential support persons. These resources are designed to be shared with families and visitors wanting to know more about compassionate care and essential support persons and with long term care staff who would benefit from additional clarification under the Safe Start for Long Term Care plan.

What You Need to Know About Compassionate Care – this one-page document summarizes and explains what compassionate care is and the requirements for such a visit to occur.
What You Need to Know about Essential Support Persons – this one-page document summarizes and explains what an essential support person (ESP) is and answers a series of questions regarding what an ESP may and may not do.

Providers are urged to email the RCS Policy Unit if they have any questions. 
DEAR ADMINISTRATOR LETTER ADDRESSES COVID-19 VACCINE AND TB TESTING FOR ASSISTED LIVING
In a Dear Administrator letter dated February 10, 2021, assisted living providers were informed that tuberculosis (TB) testing requirements under WACs 388-78A-2484, -2480(1), and 2485(1) are suspended by the Department of Social and Health Services under WSR 20-24-060 due to lack of available testing statewide. However, we are aware that testing is becoming more available and you may be considering testing staff now. If you decide to test staff for TB, the Centers for Disease Control and Prevention (CDC) has published guidelines for timing TB testing and COVID-19 vaccination.

The letter also provides a link to the CDC Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States. Under the section titled “Laboratory Reporting,” the CDC provided recommendations about the timing of the administration of the mRNA COVID-19 vaccine and Tuberculosis (TB) testing products.

For either a Tuberculin Skin Test (TST) or an interferon gamma release assay (IGRA) test, the CDC recommends placing the tests prior to administering COVID-19 vaccine. If vaccine was already administered or a decision is made that receiving the vaccine is a greater priority than TB testing, the CDC recommends waiting until four weeks after the two-step COVID-19 vaccination process is completed before administering the TB test. The CDC also recommends:
  • Performing TB symptom screening on all healthcare personnel or residents, and
  • All potential recipients of COVID-19 vaccination weigh the risks and benefits of delaying TST/IGRA with their providers.

The letter directs providers to email Jeanette Childress, Assisted Living Facility Policy Program Manager, or call her at (360) 764-9804 if they have any questions.
OFFICE HOURS: VACCINE DISTRIBUTION IN LTC
The American Health Care Association and National Center for Assisted living (AHCA/NCAL) will be hosting office hours on Thursday, February 25, at 3 PM Eastern to answer your questions about how to continue to access vaccinations. The CDC recently posted new guidance​ on how LTC facilities should ensure ongoing access to the COVID-19 vaccine. This guidance provides three options for LTC facilities (skilled nursing facilities, nursing homes, assisted living facilities, and other congregate living setting) to continue to receive the vaccine. The office hours will provide an overview of this guidance and provide attendees an opportunity to ask questions. Please note that registration is limited, but a ​recording will be available within 24 hours and open to everyone.
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.