COVID-19 UPDATE #24
April 24, 2020
ADDITIONAL $420 BILLION TO BE DISTRIBUTED TO MEDICARE PROVIDERS TODAY
The Department of Health and Human Services (HHS) has provided an explanation of the formula for distribution of provider relief funds. HHS allocated another $20 billion today to all Medicare providers. You may have received a check already and if not, you should over the next week. HHS intends to send checks to Medicaid-only providers but is not doing so in this payment. We will continue to work with HHS to develop the system to get those funds distributed.
The notice from HHS is confusing, but here is the explanation. Combined with the $30 billion two weeks ago, with this $20 billion payment, HHS has now paid $50 billion to Medicare providers. Here is the formula:
  1. Start with $2.5 trillion, which is what they calculate as the spend for all Medicare providers.
  2. Divide each provider’s revenue by $2.5 trillion to get the percentage attributable to each building.
  3. Multiply the provider’s percentage by $50 billion (the full amount of payments to all providers) to determine the amount for each provider.
  4. For the payments going out this week, HHS is then deducting the amount distributed two weeks ago to determine the final payment.
Or:
 
( [ Facility' s 2018 Net Patient Revenue   ÷   $2.5 Trillion ×  $50 billion ) -   Amount given in 1st payment   =   New distribution amount

HHS has developed a FAQ for the Provider Relief Fund   with additional details.
In addition, HHS paid out another $20 billion from the fund, but it appears that all that money is going to hospitals. While we acknowledge that hospitals need financial assistance, the battle against COVID-19 is being fought in long term and post-acute care facilities. We will be demanding fair treatment for our facilities in upcoming payments.
The good news is that Congress added $75 billion in funds to this HHS effort, so even with these payments, there is over $100 billion left in the Provider Relief Fund. We and AHCA/NCAL is doing everything possible to get you what you need out of this fund.

A future distribution will focus on Medicaid-only providers who do not have Medicare cost reports. As we learn additional detail about the distribution formula, AHCA/NCAL will provide more information.
EMERGENCY FUNDS FOR MEDICAID ASSISTED LIVING PROVIDERS
Bea Rector, Director of DSHS Home and Community Services Division, has reported that the state of Washington has received approval from CMS to distribute enhanced FMAP dollars to assisted living Medicaid providers in the form of an add-on payment of $9.30 per Medicaid patient day. The funding will be retroactive to March 1, and will be allocated through June 30, 2020. Additional dollars to hold COVID-19 rooms for impacted residents is also planned. The dollars should be distributed next week, along with instructions about retainer payments for holding resident rooms. If you have questions, please email Lauri St. Ours or contact her at (800) 562-6170, extension 104.
PREPARING FOR WIDESPREAD TESTING
The Centers for Medicare and Medicaid Services (CMS) has recently emphasized the importance of testing for COVID-19 in nursing facilities. In addition, a growing number of states are requiring testing of all residents and/or staff. When accessing testing, we recommend providers ensure that the tests are FDA approved PCR tests (versus Antibody/Serology tests) and that the lab will bill Medicare directly. Providers need to have a plan in place to isolate residents   who test positive, and follow CDC guidance   for staff that test positive. More information and guidance on preparing for widespread testing is available here .  
EMERGENCY RULES SUSPEND CERTAIN ASSISTED LIVING ADMINISTRATOR TRAINING REQUIREMENTS
The Department of Social and Health Services (DSHS) is temporarily amending portions of Chapter 388-78A-2524, 2525, and 2526 to assure assisted living providers are not significantly impeded during the hiring process due to an administrator’s inability to obtain a certificate of completion of a recognized administrator training as referenced in WAC 388-78A-2521 . This will help to increase the number of long term care administrators necessary to provide essential services to some of Washington’s most vulnerable adults during the outbreak of COVID-19.
 
The current rules require administrator training prior to assuming administrator duties or within six months of beginning duties for administrators meeting additional educational requirements. Currently, applicants for assisted living facility administrator positions are unable to obtain the required training because that training is no longer being provided due to the COVID-19 pandemic. For additional information, please email Lauri St. Ours or call her at (800) 562-6170, extension 104.
IF IT IS NOT DOCUMENTED, IT DID NOT HAPPEN
Law firm Husch Blackwell lays out some general steps for documenting activities and response efforts to be prepared for surveys and potential litigation. AHCA/NCAL also recommends working with your legal counsel to develop practices. This resource  is available to AHCA/NCAL members (log in required). 
NORTHWEST HEALTHCARE RESPONSE NETWORK - RC3
The Northwest Healthcare Response Network (NWHRN) Regional COVID-19 Coordination Center (RC3) is the product of ongoing collaboration between Western Washington Disaster Medical Coordination Centers and the NWHRN, and was established to triage and place COVID-19 and related patients requiring acute hospital care in an equitable manner across western Washington. Click here for a listing of the counties being served by RC3.

Operated 24/7 out of Harborview Medical Center, the RC3 aims to prevent any single hospital or small group of hospitals from experiencing significant COVID-19-related resource strain by balancing patient placement across the region and supporting transport coordination to hospitals with additional capacity. In addition to supporting patient/resident placement from healthcare facilities, such as long term care centers, the RC3 stands ready to assist hospitals at maximum capacity seeking to decompress by transferring a group of COVID-19 or non-COVID-19 patients to other hospitals for continued care.

Long term care facilities in western Washington with COVID-19 residents are encouraged to connect with RC3 early to assist and triage any necessary transfers to acute care hospitals. RC3 does not replace your established, normal protocols for EMS or acute care transfers. For more information visit the NWHRN COVID-19 page on their website or see information here .
UPDATE ON PENDING REQUIREMENT FOR NATIONAL HEALTHCARE SAFETY NETWORK REPORTING
As announced in a CMS memo  earlier this week, CMS will be issuing a new requirement for nursing homes to report to CDC’s National Healthcare Safety Network, which is the nation’s most widely used healthcare-associated infection tracking system. AHCA, along with other stakeholders, met with staff from CDC National Healthcare Safety Network (NHSN) to seek more information about accessing NHSN and the reporting requirements. Key takeaways providers should be aware of are:
  • There will be an option for an expedited registration and credentialing process for new users of NHSN. It is estimated to take one hour via email communication to complete this process.
  • Reporting to NHSN will likely be required weekly. 
  • There will be a probable grace period from enforcement to allow for rollout of this new requirement. CMS will determine the length of time of that grace period which is not known at this point.

The goal of reporting to NHSN is to:
  • Augment case reporting to understand facility specific impact; and
  • Identify resource needs and prioritize public health action.

NHSN will be providing training and support such as office hours and a user support desk in the coming weeks. We will share more information as it becomes available from CDC NHSN and when CMS issues the rule for these requirements.
WHCA UPDATES FAQ DOCUMENTS FOR ASSISTED LIVING AND SKILLED NURSING
Since providers began responding to the public health emergency that is COVID-19, WHCA staff has been working to provide information, answers, and resources to assist. We have compiled a list of Frequently Asked Questions (FAQs) for assisted living and for skilled nursing providers. If you and your team are looking for answers to questions you have, you may find information to help in these documents. We continue to update them as we continue to answer questions for our members.
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.