March 30, 2020
The Emergency Paid Sick Leave Act under the Families First Coronavirus Response Act (effective April 1), carried with it the possibility of staff leaving facilities for up to 12 weeks to take care of their children not in school. In response to AHCA/NCAL’s advocacy to include nursing home, assisted living, senior living and ID/DD staff in their definition of “health care provider,” the Department of Labor (DOL) has published guidance to address exemptions and employer requirements to the expanded Family Medical Leave Act and sick leave benefits included in the recently passed Families First Coronavirus Response Act (FFCRA).
On March 28, the Department of Labor clarified its position and released updated questions and answers regarding the Act. The guidance provides an exemption for all healthcare workers from expanded leave requirements.
The guidance at Question 56 specifically states:
56.   Who is a “health care provider” who may be excluded by their employer from paid sick leave and/or expanded family and medical leave?
For the purposes of employees who may be exempted from paid sick leave or expanded family and medical leave by their employer under the FFCRA, a health care provider is anyone employed at any doctor’s office, hospital, health care center, clinic, post-secondary educational institution offering health care instruction, medical school, local health department or agency, nursing facility , retirement facility , nursing home , home health care provider, any facility that performs laboratory or medical testing, pharmacy, or any similar institution , employer, or entity. This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions. 
The original DOL definition was very limited and did not include numerous health care providers that are essential to preventing and containing the spread of COVID-19. We hope that this is a bit of good news amidst this pandemic, and we thank AHCA/NCAL for its work on this and sensitivity to the need for facilities to retain staff at this critical moment.  The AHCA/NCAL guidance can be found here .
CMS announced on March 28 that it is expanding its accelerated and advance payment program for Medicare providers. These payments provide emergency funding and address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. In this situation, CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19.  
To qualify for accelerated or advance payments, the provider or supplier must: 
  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form; 
  • Not be in bankruptcy;
  • Not be under active medical review or program integrity investigation; and 
  • Not have any outstanding delinquent Medicare overpayments. 
Medicare will start accepting and processing the Accelerated and Advance Payment Requests immediately. CMS anticipates that the payments will be issued within seven days of the provider’s request. See an informational fact sheet on the accelerated/ advance payment process and how to submit a request.  It is important to note that this is a cash advance from Medicare and that all amounts received will be coupled beginning 121 days after the advance payment is received and must be paid back to Medicare by day 210.
CMS guidance on provider eligibility and submission processes from today’s announcement differ from those found in the Medicare Financial Management Manual , Overpayments, Chapter 3, Section 150. Providers should contact their MACs directly, to understand how the MAC will be operationalizing CMS’s guidance. CMS is delegating the payment request processing to the MACs. See the MAC regional coverage map.  
The website for WPS is here . The website for Noridian is here .
Due to the documented risks regarding facility staff sharing and/or employment at multiple healthcare locations, it is imperative that assisted living and skilled nursing facilities query all staff regarding other places of employment and/or volunteer sites that may be at risk or experience a COVID-19 outbreak. Please encourage your staff to share this information, voice concerns, and report to your facility any suspected/confirmed exposures.
Currently there is no public or consolidated list of LTC facilities, sites, or workplaces. However, WHCA has done its best to track those facilities that have been impacted and it is ready to help you. As you are aware, this information is changing daily, if not hourly in some cases. In light of the need to actively monitor this situation, recommendations include:

  1. Obtain information from each staff member regarding shared employment, volunteer work, etc. Ask them to share promptly any information they receive regarding potential or confirmed exposure. Document this information and ensure all staff are actively screened per CDC Guidance.
  2. Call the facility, entity, or workplace directly and start a dialogue with the administrator/ED or person in charge for any identified employee regarding any confirmed or suspected outbreaks in the interest of public and facility protection. Be open and actively share this information with these workplaces as well if your facility experiences a COVID-19 outbreak. (Do not share any specific staff or resident medical information.)

If you are not able to obtain information regarding another LTC facility, please directly email Vicki McNealley or Elena Madrid and we can check what listed facility resources we have available at that time.
CMS issued a QSO memo on March 10, 2020, stating that fit testing verification by State Survey Agencies is to be held until further notice. N95 fit testing is expensive, you have to waste a mask for every mask you fit, and the fit tests are not necessary at this time. Page two of the memo states:
Due to the updated CDC guidance and current supply demands of these devices (and the discards associated with testing), CMS is directing surveyors not to validate the date of the last FIT test for health care workers in Medicare and Medicaid certified facilities, until further notice.
CMS recently issued an electronic tool kit regarding telehealth and telemedicine for skilled nursing centers. CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. 

 This document contains electronic links to reliable sources of information regarding telehealth and telemedicine, including the significant changes made by CMS in response to the National Health Emergency. Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well. 
There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, and software, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic.
WHCA was notified that in some areas, local postal workers are refusing to comply with screening requirements (temperature check and sign in). This is an issue managed at the local level. With great concern about the impact on secure delivery of medications and financial documents, we elevated this issue to the federal level. AHCA has taken up the issue, and recently reported the United States Postal Service (USPS) will be offering centers and other customers three options in a letter going to all postal customers for mail delivery if there are issues with current delivery: 
  1. You may opt to redirect to a temporary mail receptacle inside or outside the building where screening would not be necessary. 
  2. Place the mail on hold at the Post Office servicing this delivery. Mail and parcels can be held up to 30 days and will be available for customer pickup. 
  3. Redirect all mail for the business to an alternate location. 
AHCA/NCAL joined forces with other national associations to send a letter to the Postmaster General and Chief Executive Officer of the U.S. Postal Service to express concerns and will keep us apprised about subsequent developments.
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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.