COVID-19 UPDATE #43
June 11, 2020
CARES ACT FUNDING NOW AVAILABLE FOR MEDICAID PROVIDERS
The Department of Health and Human Services (HHS) announced today that $15 billion of federal funding through the Coronavirus Aid, Relief, and Economic Security (CARES) Act  is now available for Medicaid providers, including skilled and assisted living providers.

If you plan to apply for this funding, you must submit annual patient revenue information to the HHS provider relief fund portal .

Details about this HHS funding:
  • Eligibility: Any provider that did NOT receive a funding award from the first $50 billion in awards made to providers with some level of Medicare utilization, and directly billed a state Medicaid program or Medicaid managed care plan between January 1, 2018, and May 31, 2020.
  • Award amounts: Minimum of 2% of gross patient care revenues, with final amount determined by provider-submitted data including number of Medicaid patients served.

We will share any additional information we receive on the process when received from HHS. The American Health Care Association and National Center for Assisted Living have been working with HHS on this issue and have created a resource page for providers.
CMS ISSUES FINES FOR INCOMPLETE NHSN DATA SUBMISSION
This morning we learned that skilled nursing providers are receiving citations under F884 at F level. The citations are imposing civil monetary penalties of $1,000 per instance. The citations are going to any skilled nursing facility flagged by CMS as not having submitted data or submitting incomplete data to the National Health Safety Network (NHSN) for the week of June 1 to June 7.

Skilled nursing facilities are required to submit data to CDC through the NHSN portal. Starting June 1, any skilled nursing facility that does not submit the required data will be fined. If the facility in subsequent weeks fails to submit data, the fine escalates. As of last week, approximately 90% of skilled nursing facilities have successfully registered.

Civil fine notifications are being sent via the CASPER/QIES system (not the normal method for notifying a facility with a deficiency). Thus, facilities must go into their CASPER account to see whether or not they have a citation. CMS has said a facility can appeal the citation and CMP through the IIDR process by following the steps outlined in the notification letter .

We recommend that our SNF members:
  1. Check CASPER to see if you have a citation.
  2. If you have a citation that you believe is in error, you should assemble the information needed to submit an IIDR. We recommend putting together at least the following:
  • A summary table of dates you started the registration process and all dates of communications with CDC/NHSN
  • Screen shots if you have documented your data submission
  • Copies of emails sent and received from CDC/NHSN
  • Any other documentation of your efforts to register and submit data, such as communications with the QIO or state

For additional information please look at these FAQs . WHCA will continue to work with our partners at AHCA to keep you informed of ongoing developments.
NAR WAIVER EXPIRATION CONCERNS PROVIDERS: EXTENSION REQUEST IN THE WORKS
Washington providers who employ Nurse Assistants Registered (NARs) continue to be concerned about the extension of the 120-day waiver on completion of CNA testing and licensing. The current waiver is set to expire on June 17. In an emergency, Governor Inslee is only able to extend a waiver of state laws and regulations for 30 days; all other extensions are subject to approval from the legislative “four corners,” the leaders of the House and Senate Democrat and Republican caucuses.

This waiver has been extended by the leaders of the Legislature with past requests for the extension, and we believe there is great interest in ensuring we are able to retain these key direct care workers. WHCA has been working very closely with the Governor’s Office and DSHS regarding the need to extend the timeline on this waiver by at least 60 days while we work on developing a legislative solution to ensure that the NARs who are currently employed and working diligently to protect their residents can remain employed. Of particular concern is the fact that testing for CNAs is currently quite limited since sites have not fully re-opened. If you have questions or want to share additional information about the need for this ongoing waiver, please email Lauri St. Ours . Your feedback about the need to extend these timelines is welcomed.
DSHS ISSUES DEAR ADMINISTRATOR LETTERS FOR SKILLED NURSING CENTERS
The Department of Social and Health Services (DSHS) has issued a Dear Administrator letter dated June 10, 2020, regarding enhanced enforcement for infection control deficiencies and quality improvement activities in nursing homes. The letter refers to QSO-20-31-All that outlines directives for nursing home and state survey agencies. The Centers for Medicare and Medicaid Services (CMS) has initiated performance-based funding requirements tied to the Coronavirus Aid, Relief, and Economic Security (CARES) Act supplemental grants for State Agencies. Part of the funding will be contingent on the completion of focused infection control surveys, and available funding will be reduced if those surveys are not completed for every nursing home by July 31.

A second Dear Administrator letter dated June 10, 2020, addresses the release of COVID-19 nursing home data and QSO-20-33-NH regarding the posting of nursing home inspections. In addition to the new reporting requirements implemented on May 8, 2020, CMS has also announced they will be posting the results of surveys and complaint investigations conducted on or after March 4, 2020. This information will be posted on June 4, 2020, on Nursing Home Compare in the “Spotlight” section and will be updated monthly. While the inspections will be posted publicly, the results will not be used to calculate a nursing home’s health inspection star rating.
CDC TO OFFER WEBINAR ON INFECTION PREVENTION AND CONTROL STRATEGIES IN NURSING HOMES
On Tuesday, June 16, the Centers for Disease Control and Prevention (CDC) Clinical Outreach and Communication Activity (COCA) will be hosting a webinar on applying COVID-19 infection prevention and control strategies in nursing homes. CDC presenters, Dr. Nimalie Stone and Dr. Kara Jacobs-Slifka, will use case-based scenarios to discuss how to apply infection prevention and control guidance for nursing homes and other long term care facilities that are preparing for and responding to COVID-19.

Applying COVID-19 Infection Prevention and Control Strategies in Nursing Homes  will be offered Tuesday, June 16, at 11:00 a.m. Click here for the details and how to join. If you are unable to attend the live COCA Call, the recording will be available for viewing on the COCA Call webpage a few hours after the live event ends. The slide set will be available under "Call Materials" on the COCA Call webpage .
DOH UPDATES THE FAQ DOCUMENT CREATED FOR TESTING QUESTIONS
In response to RCS Dear Provider letters ALF #20-027 and NH #20-037 issued on June 3, 2020, the Department of Health (DOH) and the Department of Social and Health Services (DSHS) created a Frequently Asked Questions document . They have added information to the document and updated it based on additional questions they have addressed.
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.