KHCA/KCAL is committed to providing our members with important updates. Below is a list of the most recent COVID-19 updates. Please visit our website for a list of complete updates. www.khca.org
1135 Waiver Request
As mentioned on last Friday’s KHCA/KCAL weekly update conference call, KHCA, LeadingAge Kansas, KACE and the Kansas Hospital Association have been collaborating on the 1135 waivers being submitted to CMS and Governor Kelley. The following are the 1135’s that were sent last week.  Please keep in mind that these are our “Asks” and not the final items that are approved.  
 
KHCA/KCAL will update you the minute we know what has and has not been approved on the waiver.
 
 
AHCA/NCAL Says Segregated COVID-19 Units Best Path for Hospital Discharges
​States considering steps to mandate that skilled nursing facilities (SNFs) accept hospital discharges who may have or actually already have the coronavirus (COVID-19) should instead work to direct SNFs to create as many segregated COVID-19 units as possible, leaders of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said.
The association also said it was vital for states to ensure SNFs possess the necessary Personal Protective Equipment (PPE) to keep staff safe while caring for frail and elderly residents most susceptible to acquiring the virus and work with hospitals to accomplish this goal.... click here to continue reading.
Department of Labor Guidance on New Leave Benefits Excludes Health Facility Employees
In response to AHCA/NCAL’s advocacy to include nursing home, assisted living, and ID/DD staff in their definition of “health care provider,” the Department of Labor has published guidance to address exemptions and employer requirements to the expanded Family Medical Leave Act and sick leave benefits included in the recently passed Families First Coronavirus Response Act. Of note, the Department’s exemptions  FAQ  (see #56) states that the “health care provider” exemption to these new leave requirements applies to “anyone employed at any... nursing facility, retirement facility, nursing home, home health care provider... This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions.” The exemption also applies to employees of contractors with the above institutions who “provide services or to maintain the operation of the facility." Employers with over 500 employees are also exempted. Please review this   FAQ   closely. 
 
To minimize the spread of the virus associated with COVID-19, the Department encourages employers to be judicious when using this definition to exempt health care providers from the provisions of the FFCRA. 
 
Additionally, the Department of Labor has posted an  Employer Fact Sheet  and an   Employer Notice Requirements FAQ
Medicare Accelerated and Advanced Payments Now Available 
CMS announced today (March 28) that it is expanding its accelerated and advance payment program for Medicare providers. These payments provide emergency funding and address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. In this situation, CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19.  

To qualify for accelerated or advance payments, the provider or supplier must: 
  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/supplier’s request form; 
  • Not be in bankruptcy;
  • Not be under active medical review or program integrity investigation; and 
  • Not have any outstanding delinquent Medicare overpayments. 

Medicare will start accepting and processing the Accelerated and Advance Payment Requests immediately. CMS anticipates that the payments will be issued within 7 days of the provider’s request. See an  informational fact sheet  on the accelerated/advance payment process and how to submit a request.  

CMS guidance on provider eligibility and submission processes from today’s announcement differ from those found in the  Medicare Financial Management Manual , Overpayments, Chapter 8, Section 150. Providers should contact their MACs, directly, to understand how the MAC will be operationalizing CMS’s guidance. CMS is delegating the payment request processing to the MACs. See the  MAC regional coverage map .   
New Guidance on Hospital Transfers
AHCA/NCAL has revised our  guidance for long term care facilities  on accepting admissions from and transferring patients to hospitals during COVID-19 (previously released on March 20). The revisions are based on   new evidence from the CDC  published in its March 27th Morbidity and Mortality Weekly Report (MMWR), which found that  57% of elderly who tested positive for COVID-19 did not have symptoms  but shed virus at levels that likely made them infectious to others. 

As more data becomes available, this guidance may continue to change. Some State or Federal officials may issue state specific guidance that supersedes this guidance.
  
Admitting residents from the hospital 
We revised the decision-making and guidance from the earlier version. 

Based on this new CDC data,  unless a person is tested for COVID-19 and negative before admitting them to your building, you should assume the person has COVID-19 regardless of their having or not having symptoms .

The decision-making process to accept hospital admissions will vary depending on the ability of the LTC facility to manage residents who are COVID-19 positive or suspected to have COVID-19. Accepting residents from the hospital is also contingent on the LTC facility having adequate staffing levels and PPE to manage COVID positive residents. If not possible, the LTC facility should stop accepting all admissions until the facility has staffing levels and PPE to manage residents, which may not be at typical levels from prior to this pandemic.  

We strongly urge LTC facilities to begin creating separate wings, units or floors now, by moving current residents to handle admissions from the hospital and keeping current residents separate, if possible . LTC facilities should also start now to develop plans for consolidating residents between facilities to create “new” facilities that can accept hospital discharges who may be COVID positive or negative or harboring the virus because testing is not available.
  
Transferring residents to the hospital
Sending a resident to hospital, even if they test positive for COVID-19 or they have a fever or respiratory symptoms, is not always necessary. Facilities should implement droplet precaution procedure and follow   CDC guidance  for COVID-19 for all positive or presumptive cases in long term care.

If a resident requires IV fluids, oxygen and other treatments due to their respiratory symptoms, Medicare will allow you to switch the person over to Medicare Part A without a 3-day SNF stay.

Discussion with families and residents should occur about the risks of hospitalization with COVID-19 during this pandemic period.  We urge members to update residents' advanced directives accordingly after having these discussions .


Email  COVID19@ahca.org  for additional questions, or visit  ahcancal.org/coronavirus  for more information.
Kansas Health Care Association and the Kansas Center for Assisted Living
1100 SW Gage Blvd Topeka, KS 66604
PH: 785-267-6003 FAX: 785-267-0833