COVID-19 UPDATE #140
March 5, 2021
ACCESSING THE COVID-19 VACCINE IN LONG TERM CARE
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) has put together resources on how to access the COVID-19 vaccine after the pharmacy partnership concludes, as well as an overview of the COVID-19 vaccine coverage under Medicare. 

Accessing COVID-19 Vaccine in Long Term Care After the Pharmacy Partnership 
AHCA/NCAL has drafted new guidance​ on accessing COVID-19 vaccine in long term care after the LTC Pharmacy Partnership Program is completed. This guidance lays out action steps members should take immediately to ensure ongoing access to vaccine, including how they will receive and administer the vaccine. 

COVID-19 Vaccine Administration Coverage and Claim Coding in Skilled Nursing Facilities 
AHCA/NCAL has created a fact sheet providing an overview of COVID-19 vaccine coverage under Medicare Part B and how it interacts with Medicare Part A and Medicare Advantage. It discusses common situations where external mass immunizers, such as LTC pharmacies, may be responsible for vaccine administration for claim billing. For SNFs that elect to administer and bill for the COVID-19 vaccine, it summarizes the key coverage and claim coding requirements.

Skilled nursing facility billing staff should review these requirements and discuss with billing software vendors to assure that the required specifications are included to permit COVID-19 vaccine billing. A recent webinar Office Hours: Vaccine Distribution in LTC was recorded and is available, and the presentation slides are found here.
VACCINE NEEDS IN LTC | SURVEY TO SUPPORT DEPLOYMENT OF VACCINE AND SUPPORT STAFF
WHCA has created a survey for all assisted living and skilled nursing facilities to provide feedback on vaccine needs in your community. As we work with local and state officials, it will be helpful to know where needs exist for additional vaccine doses to accommodate employees and residents who want to be vaccinated. We are also looking for information on what you forecast will be necessary to maintain vaccinations for staff and residents as we move forward. Please take a couple of minutes to complete the survey to help us identify needs for additional vaccine doses and potential ongoing needs. 
SURVEY ON INFECTION PREVENTION IN AL AND SNF
The Washington State Department of Health (DOH) is working to determine how many skilled nursing and assisted living facilities have an Infection Preventionist on staff, or a staff member who has infection prevention as one of their assigned duties. They are also seeking to learn what resources and information these facilities need for infection prevention. Please assist DOH by completing this short survey, which will take approximately 10 minutes. The survey information will be used to help DOH provide resources to facilities. The survey will be open through March 25, 2021. 
CALCULATING COUNTY RATES FOR STATE SAFE START FOR LTC PLAN
Five more counties entered Phase 2 of the Safe Start for Long Term Care plan over the past week; currently there are eight counties in Phase 2 and one in Phase 3. As you are likely aware, the phases are distinctly different for long term care settings when compared to Governor Inslee’s Healthy Washington Roadmap to Recovery phased plan.

The Safe Start for Long Term Care includes four phases, and movement through the phases is county-designated (not regional) and based solely on the infection rates in the county. As you recall, all counties started in Phase 1 on February 1, 2021, when the new Safe Start for Long Term Care went into effect.

County infection rates above 75 per 100,000 population in a two-week time was the factor indicating a county’s situation in Phase 1. The phases are outlined below and reflect county infection rates per 100,000 population:
  • PHASE 1: More than 75/100,000
  • PHASE 2: Between 25 – 75/100,000
  • PHASE 3: Between 10 – 25/100,000
  • PHASE 4: Fewer than 10/100,000

Of note, of the county in which your facility is situated can move forward in a phase due to decreased community infection rates, and later if those infection rates rise, you are instructed to pause in that phase. If at anytime your county’s infection rate returns above 150/100,000 your facility must return to Phase 1 standards. Finally, the county health jurisdiction has the authority to move all facilities back to Phase 1 at their discretion.

It is important, then, to keep notes on your county’s infection rates on a routine basis. Take note of the exact number, so you can determine when to pause in that phase if necessary. To access the COVID 19 Risk Assessment Dashboard, click here. Once on this site, it is important to scroll down, past the regional map, to the Phase by County map. Here, you can determine your facility’s phase based on the Safe Start for Long Term Care plan. If you have questions, please email Vicki McNealley or Elena Madrid.
DEAR ADMINISTRATOR LETTER INFORMS PROVIDERS OF MONOCLONAL ANTIBODY INFUSION TREATMENT FOR COVID-19
In a Dear Administrator letter dated February 26, 2021, all providers are informed that the Food and Drug Administration issued an emergency use authorization for use of monoclonal antibodies (mAb) to treat mild to moderate COVID-19 in certain people. The letter provides this link to additional information about the treatment, including the Emergency Use Authorizations for casirivimab and imdevimab. The letter also explains that currently mAb are being allocated to Washington State free-of-charge. The Department of Social and Health Services (DSHS) and the Department of Health (DOH) are working to provide infusion services for mAb treatments in long term care settings.

The letter also explains that monoclonal antibodies are administered through infusion and require a nurse to start and oversee the infusion, as well as to monitor the resident after the infusion is complete. To support providers who want to administer mAb, DSHS can provide rapid response staffing resources (see December 2, 2020 letter on this topic) to backfill direct care to residents while the facility staff are performing infusions. You may request mAb allocations from your pharmacy through a physician order for residents recently diagnosed with COVID, and may request rapid response nursing to backfill direct care for residents. Rapid response teams may not perform mAb infusions. The letter encourages providers to email Bett Schlemmer, Field Operations Office Chief, if they have any questions.
AHCA/NCAL ANNOUNCES A NEW PATHWAY TO REQUEST STAFF SUPPORT FOR MONOCLONAL ANTIBODY INFUSIONS
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) announced a new, grassroots opportunity facilitating the use of interested and qualified Medical Reserve Corps (MRC) volunteers to provide staff support for administering COVID-19 monoclonal antibody infusions in long term care facilities. The Long-Term Care Infusion Support Activity (LISA) is a collaborative initiative designed and supported by six national associations, including AHCA/NCAL, that have united to form the Coalition to Advance Community-Based Solutions for COVID-19. The goals of LISA are to reduce hospitalizations, preserve U.S. healthcare system capacity, and protect America’s seniors against COVID-19. 

The LISA initiative includes: 
  • ​Detailed step-by-step instructions for activating the pathway and engaging with local MRC units and partners. 
  • Curated online training for MRC volunteers on core topics, including infection control, LTC facilities, COVID-19 monoclonal antibodies, and infusion therapy. 
  • Hands-on refresher training for MRC volunteers at a local infusion center (if available) on IV access, infusion therapy, and managing infusion reactions. 

Note that local MRC units vary widely in terms of capacity, capabilities, personnel, and competing priorities. MRC units may or may not be able to satisfy requests for LISA support. 

Action items for long term care facilities:
  • Review full details about the LISA initiative and pathway. 
  • Share this information with your facility and/or corporate leadership.

If your facility would like to request monoclonal antibody infusion support through LISA, look up contact information for the Director of your local MRC unit(s). Select a state, then click map location(s) for phone/email and inquire about the availability of LISA volunteers.
KING COUNTY HEALTH HOSTING WEBINAR ON WHAT TO EXPECT IN 2021
King County Public Health officials and experts will be providing a free, interactive webinar on Wednesday, March 10, 2021, from 1:00 – 2:30 PM for long term care professionals working in King County retirement communities, memory care facilities, skilled nursing facilities, or adult family homes. The webinar will be moderated by Dr. Albert Munanga, DrBH, MSN, RN, HC, of Era Living. Speakers will include Dr. James Lewis, MD, MPH, Shauna Clark, RN, and Maureen Linehan, MPA.
 
During this webinar, participants will:
  • Hear what summer 2021 could look like for long term care facilities in King County.
  • Get insights about local vaccine distribution.
  • Get your questions answered by a team of experts in the local pandemic response.

Advance registration is required by Tuesday, March 9. 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.