COVID-19 UPDATE #138
February 23, 2021
MEDICARE ADVANCE AND ACCELERATED PAYMENTS FOR SNFs
Details on Requesting an Extended Repayment Schedule
As a refresher, Medicare Advance and Accelerated Payments (AAP) repayment terms are as follows:
  • Repayment begins one year starting from the date the accelerated or advance payment was issued.
  • Beginning at one year from the date the payment was issued and continuing for eleven (11) months, Medicare payments owed to providers and suppliers will be recouped at a rate of 25%.
  • After the eleven (11) months end, Medicare payments owed to providers and suppliers will be recouped at a rate of 50% for another six (6) months.
  • The recoupment method is reduction of each claim by 25% and, after 11 months, 50%. 
  • The 50% claims reduction continues for six (6) months. 

Ability to Submit ERS Applications
After the six (6) months end, the Medicare Administrator Contractors (MACs) will issue letters for any remaining balance of the accelerated or advance payment(s). If a letter requiring reimbursement is issued, providers and suppliers will have 30 days from the date of the letter to repay the balance in full. If payment is not received within 30 days, interest will accrue at the rate of 4% from the date the letter was issued, and will be assessed for each full 30-day period that the balance remains unpaid. Information related to Extended Repayment Schedules will be included in these letters. Click here and scroll down to Section 50 for a link to the federal CMS guidance. Providers and suppliers will only be able to request ERSs after the 30-day demand letters are issued.
FRAUDULENT N95 MASKS
Long term care facilities should be aware of potential scams and fraudulent PPE, including the latest scam with N95 masks. The government is investigating massive quantities of counterfeit N95 masks that were released on the market. These masks did not go through the rigorous testing that true N-95 masks go through. Several hospitals and other healthcare entities in at least five states have inadvertently purchased these counterfeit N95 masks. 3M, the largest manufacturer of N-95 masks, provides information on their website with the latest counterfeit alerts with model numbers. 3M also advises on key strategies to lower your risk of accidentally purchasing counterfeit N95 products: 
  • ​Both masks and packaging should be labeled with “NIOSH-Approved”.
  • Legitimate N95s do not have ear loops, but rather straps or headbands and there are no decorative accents.
  • “NIOSH” must be spelled correctly.
  • There should be an approval number on the mask (review fraudulent mask numbers).
  • Be aware of high cost and large quantities as this should be a red flag warning of potential scam.

The Department of Justice is monitoring and investigating reports of COVID-19 fraud. You can report counterfeit medical supplies and other types of COVID-19 fraud at the National Center for Disaster Fraud.
DEAR ADMINISTRATOR LETTERS PROVIDE VALUABLE INFORMATION FOR ALL PROVIDERS
The Department of Social and Health Services provides valuable information to providers via Dear Provider letters. Three letters were recently released that provide vital updates on COVID-19 screening, travel advisory restrictions, and interim recommendations for the co-administration of the COVID-19 vaccine and other vaccines.

In a Dear Administrator letter dated February 18, 2021, all providers are reminded of the standing order for COVID-19 screening in certain congregate facilities, homes, and agencies. The letter references the standing order issued by the Department of Health on January 25, 2021, to facilitate universal screening of residents, clients, and staff at certain congregate living settings (adult family homes, assisted living facilities, enhanced services facilities, certified community residential settings, and intermediate care facilities for individuals with intellectual disabilities). Click here to read the order.

In a Dear Administrator letter dated February 18, 2021, the Department of Social and Health Services (DSHS) reminds providers of the travel advisory/restrictions and Governor’s proclamation 20-83. Governor Jay Inslee issued a travel advisory for Washington urging people arriving in or returning to Washington State from interstate and international travel to self-quarantine to slow the spread of the virus. Governor Inslee also issued Proclamation 20-83, ordering a 14-day quarantine for anyone entering Washington State after visiting the United Kingdom, South Africa, and other countries where a new variant of the SARS-CoV-2 virus, 501Y.V, has been circulating. The order applies to anyone who has been present in these countries 14 days prior to returning to Washington State.

The travel advisory and Governor’s order pertains to all Washington residents and visitors, including all staff and residents of your facility or home, and all providers and clients. Please share this information with all staff, residents, and clients.

In a Dear Administrator letter dated February 17, 2021, providers are given interim recommendations for co-administration of COVID-19 vaccine and other vaccinations. The letter explains the Centers for Disease Control and Prevention (CDC) has strongly stated the importance of continuing with routine vaccinations during the COVID-19 pandemic, and offered guidance for the timing of administering the COVID-19 vaccine in relation to other vaccinations, including influenza, pneumococcal, and shingles vaccines. The CDC recommendations are found under the subsection titled “Coadministration with Other Vaccines”

If providers have questions about any of these issues, they are encouraged to email the RCS Policy Unit.
AHCA/NCAL UPDATES MEDICARE 3-DAY STAY AND BENEFIT PERIOD WAIVERS FACT SHEET AND FAQs
AHCA/NCAL recently updated the COVID-19-related 3-Day Stay and Benefit-Period Waivers for Medicare Part A SNF PPS fact sheet and frequently asked questions (FAQ) resource. Key updates to the file consist of a notification that the COVID-19 public health emergency (PHE), which can be extended in 90-day increments, was recently extended through at least April 21, 2021. Additionally, a link to an AHCA/NCAL 45-minute webinar on these waivers and 11 new AHCA/NCAL-developed FAQs providing additional clarifications on common waiver-related questions submitted are included.  
 
Examples of topics covered in the updated fact sheet and new FAQs include: 
  • ​Will Medicare Part A cover asymptomatic beneficiaries that have a positive COVID-19 test result or have received the COVID-19 vaccine and have had a reaction?  
  • Various waiver-related coverage and billing scenarios. 
 
Providers are encouraged to review these updates and share with applicable clinical and billing staff. 
DEAR ADMINISTRATOR LETTER INFORMS SNFs OF CR-103 FILED TO EXTEND EMERGENCY RULES RELATED TO DISASTER AND EMERGENCY PREPAREDNESS
In a Dear Administrator letter dated February 18, 2021, skilled nursing providers are informed the Department of Social and Health Services (DSHS) filed an emergency rule (WSR 20-14- 026) related to fire drills, windows in resident rooms, and quality assurance requirements in response to the significant threat of COVID-19. RCS filed a CR-103E (WSR 21-05-059), effective February 18, 2021, to extend the amended rule for a second time. The rule expires on June 16, 2021. Here is a summary of some of the changes:
  • Current nursing home rules require periodic fire drills as well as staff training about how to respond to a fire. WAC 388-97-1740 was amended to remove the requirement for periodic fire drills. Training on responding to a fire is still required.
  • Amendment of WAC 388-97-1760 reduced the scope of quality assurance activities. Facilities must continue to review adverse events and infection control.
  • Current nursing home rules require a transparent glass window in each resident room. Amendment of WAC 388-97-2400 waives the requirement for a transparent glass window. This will increase the ability for facilities to increase capacity temporarily by utilizing windowless space for resident rooms.

The adoption of the emergency rule helps to align state rules with rules the Centers for Medicare and Medicaid Services (CMS) have waived or amended in response to the COVID-19 pandemic. Additionally, DSHS filed a CR-101 (WSR 20-21-034) on October 12, 2020, to begin permanent rule making on the above rules and other related rules. The letter encourages providers with questions to email Lisa Herke or call her at (509) 209-3088.
DOH PROVIDES ADDITIONAL RESOURCES FOR LTC PROVIDERS
During the weekly call with the Department of Health, several resources were shared with those participating. Since the information is of value to all providers, we are sharing the resources identified. You may also access the Q&A from the call here.

For King County providers, there is a number of BINAX NOW antigen test cards available free of charge to long term care facilities. These test cards are for long term care facilities in KING COUNTY ONLY. These tests will expire on or before 4/11/21. Click here for instructions and information required to submit the request to receive the cards.
OFFICE HOURS: VACCINE DISTRIBUTION IN LTC
AHCA/NCAL will be hosting office hours on Thursday, February 25, at 3:00 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 settings) 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.