COVID-19 UPDATE #72
August 28, 2020
HHS ANNOUNCES RELEASE OF 1.5 MILLION N95 RESPIRATORS FROM STRATEGIC NATIONAL STOCKPILE FOR DISTRIBUTION TO NURSING HOMES
The U.S. Department of Health and Human Services (HHS) announced the release of 1.5 million N95 respirators from the Strategic National Stockpile (SNS) for distribution to approximately 3,336 nursing home facilities across the United States. Beginning August 28, the Defense Logistics Agency will direct shipments of N95 respirators to select nursing homes that recently reported having enough supplies for only zero to three days of operations. These respirators are meant to supplement existing supplies of personal protective equipment (PPE) and will provide a seven-day supply for each nursing home to support an entire shift before discarding used products.

What’s next? The quantity of respirators distributed to each nursing home will be based on the number of medical staff employed at the facility, as reported to the Centers for Medicare and Medicaid Services (CMS) database. Each state’s governor was notified of the pending shipments during the Vice President’s call with governors on August 18. These shipments support only Medicare and Medicaid-approved nursing homes and are in addition to prior shipments of PPE distributed in order to safeguard our most vulnerable populations during the COVID-19 pandemic.
UPDATE: HHS EXTENDS APPLICATION DEADLINE TO SEPTEMBER 13 FOR MEDICAID PROVIDERS
HHS has announced another application deadline extension for the Phase 2 general distribution of relief funds to Medicaid, Medicaid managed care, Children's Health Insurance Program (CHIP), and dental providers. The new application deadline has been EXTENDED to Sunday, September 13. The formerly extended deadline was Friday, August 28.

Previously, HHS had also announced an update to payments for providers who had a change in ownership, so we encourage you to read the details closely in the announcement should this apply to your organization. Should you be looking for additional information on the Medicaid application process, a webinar was recently hosted and a recording is available. Argentum has also provided an example NPI worksheet for HHS and an HHS Provider Relief Fund Cheat Sheet to help you apply for these funds should you choose to do so.
N95 FIT TESTING: CAN A REGISTERED NURSE PERFORM THE MEDICAL EVALUATION?
WHCA has recently made members aware of the necessity of implementing a Respiratory Protection Program in your facility. As described in the program, the medical evaluation form is a questionnaire that solicits information that must be reviewed by a physician or other licensed healthcare professional (PLHCP) to determine an employee’s ability to use a respirator. It must be completed before initial fit testing is performed and before the decision is made that an employee is required to use a respirator in the work environment. It is mandatory that employees be evaluated by a physician or other PLHCP who provides a written recommendation regarding the ability to use respirators. The PLHCP needs to be an individual whose legally permitted scope of practice allows them to independently provide, or be delegated the responsibility to provide, some or all of the healthcare services required in the medical evaluation. 

We have been attempting to verify whether this function can be completed by a registered nurse (RN), saving you the necessity of sending this type of evaluation outside your facility if you have an RN on your staff.  We reached out to Labor and Industries Division of Occupational Safety and Health (DOSH) and the Nursing Care Quality Assurance Commission (NCQAC) for clarification of this issue.

While DOSH has condoned the practice of using an RN for this situation, the NCQAC has advised that this type of medical regimen can only be performed under the direction or delegation of an MD, DO, ARNP, or PA. Further, any protocols, standing orders, or policy and procedures should be in place to direct the RN to take action on responses that may require additional testing or assessment.

Facilities must proceed with caution when performing the medical evaluation portion of the Fit Testing Program and assure that protocols as defined in WAC 296-842-14005 and WAC 296-842-2205 be followed. If you have questions, you should check with your facility medical director or contact the NCQAC directly to confirm whether an RN in your facility would qualify to do the medical evaluation. WHCA will continue to work on this issue and will update you if there are any changes.
RECORDING OF MEMBER WEBINAR WITH MARK PARKINSON AND DR. DAVID GIFFORD NOW AVAILABLE
Today's AHCA/NCAL member webinar, "New CMS Testing Requirements for Staff & Residents: What You Need to Know," with President and CEO Mark Parkinson and Chief Medical Officer Dr. David Gifford is available to access now. While today's live session was restricted to facility members only, the recording is open to everyone. We are also providing resources and materials from the webinar.

*This information applies to all Medicare clients in both assisted living and skilled nursing.
DSHS DEAR ADMINISTRATOR LETTERS PROVIDE IMPORTANT INFORMATON FOR SNFs
A Dear Administrator letter to skilled nursing providers dated August 25, 2020, provides an update on the National Healthcare Safety Network (NHSN) state reporting portal for COVID-19 data. The letter summarizes testing questions removed and added to the Resident Impact and Facility Capacity module.

A Dear Administrator letter to skilled nursing providers dated August 28, 2020, addresses enforcement cases held during the prioritization period and revised survey prioritization. The letter provides an overview of the expansion of survey activities in skilled nursing including enforcement guidance, plans of correction and expanded desk review policy, processing enforcement cases based on their date of initiation, and CMP collections.

A Dear Administrator letter to skilled nursing providers dated August 28, 2020, provides additional information about the CMS announcement regarding new infection control training.

A Dear Administrator letter to skilled nursing providers dated August 28, 2020, provides information on the CR103-E filed to extend emergency rules amending nursing home requirements and the CR-101 filed to consider permanently amending the rules for physician services.
AHCA PROVIDES INSIGHT ON CMS GUIDANCE ON STAFF TESTING AND REPORTING REQUIREMENTS IN SKILLED NURSING
The American Health Care Association (AHCA) has provided an update on the additional guidance on staff testing and reporting requirements issued by the Centers for Medicare and Medicaid Services (CMS). The AHCA synopsis addresses the new guidance, QSO Memo20-38-NH and QSO Memo 20-37-NH. Click here to read their complete update.
CMS LAUNCHES NATIONAL TRAINING PROGRAM
The Centers for Medicare and Medicaid Services (CMS) has announced the launch of its national nursing home training program for frontline nursing home staff and nursing home management. The training, called “CMS Targeted COVID-19 Training for Frontline Nursing Home Staff & Management,” is available now on the CMS Quality, Safety, and Education Portal. Participants will receive a certificate upon completion of the program, which consists of five specific modules designed for frontline clinical staff and ten designed for nursing home management. 

In addition, CMS and the Centers for Disease Control and Prevention (CDC) will also have subject matter experts available on bi-weekly webinars from August 27, 2020, through January 7, 2021, from 4:00 – 5:00 PM Eastern to answer questions. Participants must register for these Q&A sessions on the Zoom webinar registration page here.

At the time of the original announcement about the training in July, CMS noted that providers would be required to participate in an online infection control training program to be eligible for enhanced funding. Based on the latest announcement, participation in this training currently is voluntary and not tied to any funding. Nonetheless, AHCA encourages all providers to take advantage of these courses as they are developed based on challenges and findings that CMS and CDC strike teams have found when visiting nursing homes with outbreaks. When CMS or HHS makes any announcement about mandated training tied to funding, we will notify members.

For more information about the training, click here. While registering for the training is not required, AHCA encourages providers to do so. 
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.