COVID-19 UPDATE #25
April 28, 2020
FIVE STAR UPDATES, NURSING HOME STAFF COUNTS, AND FAQs
On April 24, 2020, the Centers for Medicare and Medicaid Services (CMS) released a memo ( QSO-20-28-NH ) with updates on Nursing Home Compare (NHC), Five Star, public staffing information, and a list of frequently asked questions (FAQs).

Inspection Domain of Five Star Quality Rating System Will NOT be Updated Due to Prioritization of Surveys
CMS will temporarily hold constant the inspection domain of Five Star to prevent an unequal impact on the rating for those facilities who receive a survey during this time. This freeze will begin with the scheduled Nursing Home Compare update on April 29, 2020. 

CMS will post the results of any health inspections conducted on or after March 4, 2020, on the landing page of Nursing Home Compare, but they will not be used to calculate a center’s Five Star inspection rating.

The Quality Measure and Staffing domains of Five Star will be updated on April 29 as they are not impacted by the CMS blanket waivers  because they rely on data from before March 1, 2020.

Release of Certain Staffing Information
CMS will use Payroll-Based Journal staffing data to publicly report the average number of staff onsite at each nursing home each day (both nursing staff and total staff) and will also post aggregated data at a state and national level. The publicly-posted information will include all staff listed in section 2.3, Table 1 of the PBJ Policy Manual .

This information will be based on data submitted for the fourth quarter of 2019. CMS states this information can be used to help local, state, and federal agencies plan for how much personal protective equipment (PPE), testing and other resources providers may need. Providers can also use this information along with the CDC PPE burn rate calculator .

CMS FAQs
The memo includes a FAQ document that addresses CMS guidance in the areas of visitation, surveys, waivers, and more. The FAQs provide information on topics including: 
  • Individuals entering and leaving the nursing center, including visits by health care personnel, visitation for compassionate care situations, and residents who want to leave the facility against medical advice;
  • Surveys and infection control self-assessment, including the ongoing suspension of standard surveys and the recommended use of the infection control focused survey protocol for self-assessment on infection control practices and preparedness;
  • Waivers of Federal requirements including those related to in-facility and inter-facility cohorting; and,
  • Additional information on resident cohorting, separation, and admission.

CMS reminds providers that a negative test for COVID-19 is not a prerequisite for discharging a resident to a nursing home from the hospital; however, consistent with current guidance, admissions decisions should be made based on the resident’s clinical status and the ability of the accepting facility to meet their care needs and infection control requirements. Providers who can’t meet the needs of the residents due to PPE, staffing, or other issues should not accept the person. 

CMS is allowing civil money penalty (CMP) funds to be used for purchasing devices such as tablets or web-cams as well as accessories, with a maximum of $3,000 allowed per facility, to help with communications between residents and their families or friends. To apply to receive CMP funds for this purpose, contact your state agency’s CMP contact
DEAR ADMINISTRATOR LETTER ANNOUNCES CLOTH FACE COVERINGS TO BE SHIPPED TO SOME FACILITIES
In an April 27, 2020, Dear Administrator letter , providers are notified that a one-time shipment of reusable cloth face coverings for staff and residents will be sent to all long term care facilities where there is no incidence of suspected or confirmed COVID-19. Cloth face coverings will not be distributed to facilities with suspected or positive COVID-19 cases in staff or residents.

If your facility receives this shipment, all staff and residents should be offered at least one cloth face covering. Please review and follow Department of Health (DOH) guidance on cloth face coverings for appropriate use and care. The DOH and the Centers for Disease Control and Prevention (CDC) guidance now recommend that people wear face coverings when they are in a public settings where they cannot maintain six feet of distance from others. This might include trips to a store, pharmacy, health clinic, or similar places.
CONTINUING RESTRICTIONS ON VISITORS IN LONG TERM CARE FACILITIES
Even as states are beginning to lift their stay-at-home orders, nursing homes must continue to maintain current restrictions on visitors. As a reminder, CMS released guidance on March 13 that required all nursing homes to significantly restrict visitors and nonessential personnel, as well as restrict communal activities. The guidance indicates that individuals other than essential health care staff and visits for end-of-life situations should no longer enter nursing homes until further notice.

Even though certain states may be lifting their individual stay-at-home orders, nursing homes must continue to follow this directive from CMS until new guidance is received. For help communicating these policies, please see the sample letter to families provided by AHCA/NCAL on restricting visitors.

Assisted living communities must follow any applicable state guidance. If no state guidance is issued, we recommend they follow AHCA/NCAL guidance  and continue restricting the number of people entering the facility.

For all long term care communities, these restrictions remain critical safeguards to help protect against the spread of COVID-19.
EEOC SAYS EMPLOYERS CAN REQUIRE COVID-19 TESTING
The Equal Employment Opportunity Commission (EEOC) has issued welcome guidance for employers who are seeking to take all steps necessary to eradicate the virus from their facilities. This guidance is of particular importance for employers in seniors housing, assisted living, nursing homes, and other health care related fields. Read more . Many thanks to Lane Powell for this article.
WA-PALTC TO HOST WEBINAR
The Washington State Society for Post-Acute and Long Term Care Medicine (WA-PALTC) is hosting a webinar titled COVID-19 in Nursing Homes: To Test or Not to Test? Is That Even a Question? on Wednesday, April 29, 2020, at 6:00 p.m. You are invited to join experts and leaders from King County Public Health to learn more about what we know about the accuracy of current tests available. In addition, presenters will discuss strategy to prevent and control outbreaks in skilled nursing facilities. Attendees will also learn about COVID-19 antibody testing. Register in advance .
AHCA/NCAL GRANT AND LOAN MANAGEMENT RESOURCE GUIDE
To aid members with managing the array of federal grants and loans, AHCA/NCAL has developed a basic primer  (login required) for organizing oversight and day-to-day management of these emergency resources. The guidance includes federal cost reporting guidelines as well as recommended financial management approaches for members. This document is the Association’s first version; updates will be developed as the federal government and states release new or updated guidance. 
COVID-19 RELATED LOSS AND COST CALCULATOR
Available exclusively to AHCA/NCAL members is a COVID-19 Related Loss and Cost Calculator (login required). The purpose of this Excel workbook is to offer a basic tool for members to assess allowable costs already reimbursed by pre-COVID payers, such as Medicare and Medicaid, and compare such reimbursement to shortfalls where grants and loans fill funding gaps. This tool will be particularly useful with reporting on and documenting use of the CARES Act Provider Relief Fund grants. 
UPDATED ACCELERATED AND ADVANCE PAYMENT FAQs
The AHCA Medicare Accelerated and Advance Payment FAQs  have been updated to reflect the April 26 CMS announcement that it is reevaluating the amounts that will be paid under its Accelerated Payment Program to Part A facility-based providers (including SNF) and suspending its Advance Payment Program to Part B suppliers effective immediately. 

Specifically impacting SNFs, beginning on April 26, 2020, CMS will be reevaluating all pending and new applications for Accelerated Payments submitted by SNFs and other facility-based providers in light of the $175 billion recently appropriated for health care provider relief payments. Significant additional funding will continue to be available to healthcare providers through these other programs.
DEPARTMENT OF HEALTH TO HOST Q&A FOR LTC PROVIDERS ON APRIL 30
On Thursday, April 30, the Department of Health will host a webinar at 11:00 a.m. The purpose of the webinar is to update long term care providers on the actions they have taken in response to COVID-19 and to answer questions. If you wish to join the webinar, advanced registration is required.
CMS COVID-19 ENGAGEMENT CALLS FOR WEEK OF
APRIL 27
CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to healthcare providers and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts. Below is a list of upcoming calls. All calls are recorded, and recordings are posted here.

Conference lines are limited, so it is highly recommended that you join via audio webcast on any device.

Tuesday, April 28 | 12:00 PM PST | COVID-19 Care Site Specific Calls
Dial (833) 614-0820 | Passcode 1854778 | Audio Webcast Link

Wednesday, April 29 | 1:30 PM EST | Nursing Homes
Dial (833) 614-0820 | Passcode 4680237 | Audio Webcast Link

Wednesday, April 29 | 2:30 PM EST | Dialysis Organizations
Dial (833) 614-0820 | Passcode 6965645 | Audio Webcast Link

Thursday, April 29 | 1:300 PM EST | Nurses
Dial (833) 614-0820 | Passcode 4268398 | Audio Webcast Link

Friday, May 1 | 9:30 AM PST | Lessons from the Front Lines
Dial (877-251-0301 | Passcode 9545128 | Audio Webcast Link
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.