COVID-19 UPDATE #30
May 8, 2020
DASHBOARD DEVELOPED TO DEMONSTRATE COVID-19 DATA IN AL, SNF, AND AFH FACILITIES IN KING COUNTY
Compelling Visualization of the Impact on Washington
On May 7, 2020, Public Health–Seattle & King County published the Long Term Care Data Dashboard . The dashboard provides interactive and transparent information for the community about the devastating impacts of COVID-19 on individuals living in assisted living facilities, skilled nursing facilities, and adult family homes. A notation from Public Health officials indicates that all the data included in the dashboard is preliminary and subject to change; not all reports have been verified .

The dashboard features Death Data and Case Data for King County. While the information is exclusively King County’s, this data is being closely followed by state regulators.

Death Data The dashboard includes information about the number of deaths by facility type, over time. The chart on the dashboard shows since the beginning of the outbreak, thus far the number of deaths in long term care facilities peaked at 11 reported deaths on April 5, 2020. The dashboard also provides a listing of assisted living and skilled nursing facilities with five or more deaths and a link to a list of the names of the facilities that have had at least one documented case of COVID-19.

Case Data The second tab on the dashboard illustrates that people in long term care facilities who are confirmed positive for COVID-19 have very high mortality rates and high rates of hospitalization. The case data also provide a hopeful picture regarding the number of cases reported over time, illustrating that since the beginning of the outbreak, the number of confirmed cases reported in a single day peaked on March 28, 2020.

Public Health officials note that strict limitations on visitation to individuals living in long term care facilities, strong infection control and prevention measures, and testing to inform safe isolation of sick individuals are likely all playing a part in mitigating the spread of the virus and saving lives. Special thanks to Seattle and King County Public Health and Sargis Pogosjans, Epidemiologist, for developing this dashboard.
DHHS CLARIFIES CARES ACT PROVIDER RELIEF FUND FOR SKILLED NURSING FACILITIES
In the past weeks, AHCA/NCAL has submitted an array of questions on the Provider Relief Fund. Of particular importance, health care providers have expressed concern about interplay among the April 10 and 17 allocations with the second distribution that began on April 24. The primary concern has been that if a “gross receipts” methodology is applied across both tranches, providers might have to give back some of the money even if they have sufficient COVID-related expenses or lost revenues.

Recently, the U.S Department of Health and Human Services (DHHS) staff has indicated they do not intend to recover Provider Relief Fund allocations unless: 
  • DHHS identifies an overpayment associated with revenue calculations which were incorrect based upon improper or incorrect information on the cost reports. DHHS also noted the Department is collecting tax filing information to be uploaded to verify the revenue. AHCA/NCAL recognizes the challenges associated with using tax filing information and is conveying those concerns to the Department; and 
  • DHHS will pursue providers who cannot substantiate the costs/loss of revenue. AHCA/NCAL has developed a COVID-19 Loss/Cost Calculator (AHCA member login required). 

You will find more information on the background to this here .
FEDERAL AND STATE WAIVERS UPDATE
CMS Blanket Waivers
On May 6, DSHS issued Dear Provider Letter NH #2020-031 related to federal emergency waivers for skilled nursing facilities related to COVID-19. Under the blanket federal waiver, the QAPI program has been narrowed to deal only with adverse events and infection control, the deadline on nurse aide training requirements has been extended, and discharge planning standards are amended.
 
State Waivers Extended Through May 31
Today, WHCA learned that the four caucuses of the Legislature have agreed to extend timelines for emergency rule waivers expiring on May 9. Among the extended waivers is the 120-day requirement for nursing assistant certification. Click here for the updated WHCA tracking document with updated timelines on the waived rules.
NHSN COVID-19 RETROSPECTIVE REPORTING TO
JANUARY 1 OPTIONAL
There has been some confusion as to whether or not retrospective reporting in NHSN COVID-19 module is required. AHCA has confirmed with CDC that it is optional to submit data back to January 1, 2020. CDC also stated that retrospective reporting was optional at the end of its pre-recorded NHSN training webinar held Tuesday, May 5. CDC is working on revisions to the NHSN guide and instructions to make this clearer. We are also expecting CMS to issue a memo this week that will answer several questions that have been raised about this requirement as well as the new resident, representative, family notification requirement.

Facilities must submit their first set of data by 11:59 pm on Sunday, May 17, 2020, to the NHSN Long-Term Care Facility COVID-19 Module.
  • Action: Register now for NHSN and begin collecting data starting May 8, 2020. [NOTE: registration is taking more time than expected and we encourage you to start now to avoid further delays that may impact your compliance.] 
  • The memo provides an overview of the registration process.  
  • For NHSN questions, please email NHSN@cdc.gov and add “LTCF” in the subject header. 

CMS will provide facilities with an initial two-week grace period to begin reporting cases in the NHSN system (which ends at 11:59 p.m. on May 24, 2020) . Facilities that do not begin reporting after the third week (by 11:59 pm on May 31, 2020) will receive a warning letter reminding them to begin reporting the required information to the CDC.

For facilities that have not started reporting in the NHSN system by 11:59 p.m. on June 7, ending the fourth week of reporting, CMS will impose a per day (PD) CMP of $1,000 for the failure to report that week.

For each subsequent week that the facility fails to submit the required report, the noncompliance will result in an additional one-day PD CMP imposed at an amount increased by $500. For enforcement-related questions, please email DNH_Enforcement@cms.hhs.gov .

NHSN COVID-19 reporting is not required but optional for  assisted living communities . Assisted living communities should follow specific state reporting requirements and can consult AHCA/NCAL’s guidance on notifications .

AHCA has been in touch with CMS directly on behalf of our  ICF/IID providers  and whether this is optional for them. On the NHSN site, there is a category for LTC/DD, but the CMS rule itself does not list ICF/IID as a provider type. We will keep our ID/DD providers updated once we have more information to share.

Also, CDC is offering several live Q&A sessions for nursing homes May 6-14. Details can be found on the CDC NHSN website . Scroll down to the training section.
SUMMARY OF CMS REPORTING REQUIREMENTS
AHCA developed a detailed summary of the QSO memo issued by CMS on May 6, 2020, including further information on:
  • requirements for notifying residents, representatives, and families of COVID cases,
  • NHSN reporting requirements, and
  • survey and enforcement of these new requirements.

Although CMS has provided clarification on some aspects of these new requirements in the memo, we continue to communicate with CMS and CDC on several outstanding issues and to advocate for needed flexibility including an extended grace period for NHSN reporting enforcement due to the current delays and backlogs in NHSN enrollment. Here in Washington, DSHS has issued a Dear Administrator letter dated
May 7, 2020, providing insight on the CMS reporting requirements.
CMS RELEASES MEMO ON INTERIM FINAL RULE UPDATING REQUIREMENTS FOR REPORTING AND NOTIFICATION OF CONFIRMED AND SUSPECTED COVID-19 CASES AMONG RESIDENTS AND STAFF IN NURSING HOMES
CMS released a QSO memo  addressing the Interim Final Rule requiring nursing homes to report to NHSN on COVID-19 as well as provide notifications to residents, their representatives and families.

Some highlights from the memo are listed below. AHCA is reviewing the information and will issue additional updates with further details and tools to help members comply. There are some important implementation dates members need to know.

These requirements go into effect with the publication in the Federal Register of the interim final rule on May 8, 2020.

CMS had previously communicated the effective date was May 1. However, CMS revised the effective date to be May 8, 2020.  
  • The effective date means nursing homes are required to begin notifications of residents, their representatives and families as of May 8. This means the first notification could be required to occur by May 9 at 5 pm, should the facility have any of the resident and/or staff cases on May 8 as described by CMS required to make notification. 
  • Action: Ensure system and processes for notifications are in place in your facility by May 8 to meet new requirements.

Public Posting of NHSN Data Anticipated By End of May 
CMS anticipates publicly posting CDC’s NHSN data (including facility names, number of COVID-19 suspected and confirmed cases, deaths, and other data as determined appropriate) weekly on Mondays by the end of May on the CMS website .

Multiple Q&A 
CMS provides 22 Q&A in the last 7 pages of the memo. Question 10 addresses retrospective reporting and reads as below: 
  • Q: Are facilities required to report data that predates the effective date (May 8) of the interim final rule? 
  • A: No, there is no requirement in the rule to collect older data.

New COVID-19 F-tags and Updated Survey Tools
CMS has established two new F-Tags - F884: COVID-19 Reporting to CDC and F885 COVID-19 Reporting to Residents, their Representatives, and Families.

CMS has updated survey tools including COVID-19 Focused Survey for Nursing Homes, Entrance Conference Worksheet, COVID-19 Focused Survey Protocol, and Summary of the COVID-19 Focused Survey for Nursing Homes. These updated forms are posted to the Survey Resources folder  in the COVID-19 Focused Survey sub-folder on the CMS Nursing Homes website. 

Action:  Facilities should begin using the revised “COVID-19 Focused Survey for Nursing Homes” to perform their self-assessment. Surveyors will begin using these revised documents immediately.
ATTESTATION PERIOD EXTENDED FOR CARES ACT PROVIDER RELIEF FUNDS
Today, the US Department of Health and Human Services (DHHS) announced that the attestation window and related acceptance of Terms and Conditions has been extended to 45 days (formerly 30 days) from the date a provider received a payment to attest to and accept the Terms and Conditions or return the funds. Facilities will need to identify the date of their initial funding relief payment and identify their new attestation Terms and Conditions acceptance date based on the extension. In the press release , DHHS offers an example of how the extension of the window will be operationalized.

Shortly after announcing the extension of the provider-specific attestation period, DHHS released an updated set of FAQs . Providers should review the FAQs in detail and compare these with the Terms and Conditions. Click here for preliminary highlights.
GRANT AVAILABLE TO ASSIST SKILLED NURSING PATIENTS WITH COMMUNICATIONS TECHNOLOGY
An April 28, 2020, Dear Administrator letter refers to the Communicative Technology Grant available to skilled nursing providers. The CMP Reinvestment Application, COVID-19 Communicative Technology Request is designed for this communications technology funding only. CMP funds can only be used to benefit residents in certified skilled nursing facilities. Also included on the above web page are FAQs related to this funding which you may find helpful.
 
If you are interested in this grant funding, please review the instructions carefully and complete and return the application to  cmpapplications@dshs.wa.gov . The Department will make a determination on the potential of the project to benefit nursing home residents and improve their quality of care and life. Applicants will be notified of the funding decision via email, typically within five business days.
 
The department will submit applications that exceed the $3,000 funding limit to CMS for review and consideration. If you have any questions, please contact Melissa Lawton, CMP Grant Program Specialist, at (360) 725-3204 or via email to melissa.lawton@dshs.wa.gov .
COMAGINE HEALTH OFFERING HALF HOUR HOT TOPICS WEBINAR | MAY 15 | 11:30 AM
You are invited to join Elizabeth Ross, RN, BSN, with Compassus Hospice to receive tips and guidance on Navigating Crucial Conversations in the COVID Era on Friday, May 15, 2020, from 11:30 a.m. to noon. COVID-19 has magnified the importance of knowing a resident's end-of-life wishes and providing goal concordant care. These conversations in the best of times can be difficult. How do you begin this dialogue with healthy residents and their families without causing alarm? How can we bring comfort, peace of mind, and presence when loved ones may not be able to be present? There is additional information available , and registration is available here.
WHCA UPDATES FAQ DOCUMENTS
As long term care providers work to respond to the COVID-19 pandemic impacting our region, there have been questions surrounding employees and what to do if they test positive or have been potentially exposed to COVID-19. Some have asked, what and how is information communicated? When can they come back to work? Do they use paid leave? 

We appreciate Lane Powell for providing additional questions and answers on this topic that we have incorporated into our FAQs for Assisted Living and FAQs for Skilled Nursing . We encourage you to review the updated documents if you have questions about employees and COVID-19.
DSHS APPROVES CEUs FOR WHCA HOOKED ON QUALITY VIRTUAL SERIES RECORDED WEBINARS THROUGH JULY 31
WHCA has worked with the Department of Social and Health Services Training Unit to get approval for assisted living professionals to receive CEUs for completing any of the Hooked on Quality Virtual Series approved webinars through July 31, 2020. Assisted living providers can participate in the live presentation of each webinar or complete the recorded version of the webinar through July 31, 2020, and receive DSHS-approved CEUs. 

Any assisted living facilities that register for the Hooked on Quality Virtual Series can offer the programs and resulting CEUs to any and all staff—there is no limit to the number of staff who can access the education live or via recording and get CEUs through July 31, 2020 (if facilities select the per-facility option). Individuals who register can also participate live or complete the recorded webinars for credits through July 31. This series is designed to help assisted living providers gain access to quality education for all staff without having to travel or spend time away from the community. Click here for the virtual series information and 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.