06/17/2020

Today's COVID-19 Report: Wednesday, June 17, 2020

Wednesday, June 17, 2020

Here are the latest need-to-know updates for Wednesday, June 17 regarding the COVID-19 pandemic.

Tomorrow: Webinar on Economic Relief Funding Expense-Tracking Tool from CliftonLarsonAllen 

The economic relief funding from Congress contains very specific rules for how the funds can be used by health care organizations. Tracking and monitoring is critical and can be very complicated, especially when funding is received from multiple sources (e.g. CARES Act and PPP Loans, to name a few).

LeadingAge Ohio partner CliftonLarsonAllen LLP (CLA) has created an expense-tracking tool that creates the foundation to organize and track expenditures in accordance with compliance and reporting initiatives.  LeadingAge has worked with CLA to provide and promote the use of this tool to assist members around the country. The tool continues to be updated to reflect the most recent funding and source requirements and reporting; CLA has just released version 6.0.

LeadingAge Ohio has arranged for CLA to introduce members to the tracking tool tomorrow, Thursday, June 18 at 10:30AM. The 45-minute call will begin with background info on why CLA created this tool, including key information on the HHS Provider Relief Funds; this will be followed by a brief demo on how the expense-tracking tool actually works; the last portion of the call will include some frequently asked questions.

While the webinar is free, registration via Zoom is required to participate. Registrants will receive a confirmation email containing information about joining the webinar.

ODM Shares CCURT Testing Approach

Yesterday, the Ohio Department of Medicaid (ODM) shared that Ohio’s Congregate Care Unified Response Team (CCURT) has developed an approach for testing nursing home residents and staff, guided by the following principles:

• Protect Ohioans in communities and congregate facilities, including prioritization for nursing home facilities.
• Use the best available clinical information and most recent Centers for Disease Control and Prevention guidance, including testing prioritization within minority communities.
• Empower local communities with resources to mitigate and control outbreaks.
• Leverage the private sector for resources and partnerships.

As has already been widely announced, the updated website states that “nursing homes licensed by the Ohio Department of Health (ODH) or certified by the U.S. Department of Health and Human Services, the Centers for Medicare and Medicaid Services (CMS), or the Ohio Department of Medicaid shall cooperate with the COVID-19 testing for staff and residents as required by ODH. This includes, but is not limited to, strategic testing of residents to prevent the spread of COVID-19 within a facility and a community.” Each nursing home facility in Ohio must also require all employees to be tested.  ODH will be offering a call to ALL Ohio nursing home providers early next week; information to follow.

You Asked... We Answered

You Asked: A nursing home is asking us to provide documentation that hospice staff have had a negative COVID-19 test prior to entering the facility to provide care. Can they do this? How should we proceed?

We Answered: LeadingAge Ohio has received numerous calls from Ohio hospices reporting this specific situation due to Ohio’s roll-out of mandatory testing for nursing facility staff asking whether the requirement extends to include hospices.

In nursing home guidance released in May, the Centers for Medicare & Medicaid Services (CMS) shared weekly testing recommendations for nursing home staff in both the most-restrictive phase as well as in subsequent phases of reopening. The language included a definition of staff that is inclusive of “volunteers and vendors who are in the facility on a weekly basis.”

The guidance is directed to nursing homes, and it is clearly the nursing home’s responsibility to ensure that necessary testing of hospice staff occurs. That said, the National Association of Home Care (NAHC) has clarified that:

“The nursing home does have the ability to decide who it will/will not allow into its facility and it may decide that if the hospice is not willing to test its staff with its own tests or tests the nursing home prescribes and requires the hospice to pay for, the nursing home can restrict the hospice’s access.”

Furthermore, on Monday, the Ohio Department of Health (ODH) released numerous items related to Ohio’s nursing home testing requirements, including a Q&A which addresses hospice staff in question #23, which asks:

"Which nursing home employees need to be tested? Do contract and agency staff need to be tested? Do volunteers and other types of caregivers need to be tested?"

ODH’s answer is, “The Order applies to individuals who are employees of the nursing home. Each facility in Ohio shall require its employees to be tested. Each licensed and/or certified facility must follow the infection control requirements set forth in regulations. These include developing a system of identifying and controlling the spread of communicable diseases among residents and employees, as well as all others who enter the building, including but not limited to: contract and agency staff (including hospice staff, attending physicians, etc.), volunteers, and private caregivers. As part of its infection control activities, the facility may encourage or require these types of individuals who are not employees to participate in the facility’s testing plan or verify their testing status.”

LeadingAge Ohio staff has elevated this issue to ODH, requesting more specific guidance on how testing should be paid for, documentation requirements, and any other details, including testing intervals, that would help providers put this guidance into practice. Questions may be directed to Anne Shelley at ashelley@leadingageohio.org.

Federal Relief Expansion: Assisted Living and/or Adult Day

The U.S. Department of Health & Human Services (HHS) has now posted a new portal for providers who participate in Medicaid but did not receive provider relief funding through the automatic distributions to Medicare providers. This new process will allow members who provide assisted living and/or adult day services to access federal relief funding that has been unavailable to them so far. The provider relief funding is intended to address the increased costs and lost revenue that providers have experienced due to COVID-19. Members should be aware that while these funds can be used to replace lost revenue, providers who have permanently closed as a result of the emergency are not eligible for funding. 

In addition to the new portal, HHS has also posted detailed instructions about applying for funding under the new process and a copy of the application.  HHS has established a deadline of July 20 for applying for funds through this process, but they have indicated that a total of $15 billion is available and that they will be making awards on a rolling basis, so members should apply as soon as they are able. The CARES Act provider relief fund web page also includes information about the previous payments to Medicare providers and the targeted payment to nursing facilities, including the terms and conditions of acceptance of the funds and a link to fill out the required attestation that funds will be used according to the terms and conditions.  Attestation must be made by 90 days after receipt of each payments. 

The federal government under the CARES Act has also been offering forgivable Paycheck Protection Program loans to qualified small businesses through local lenders.  Funding remains available for additional loans, so members who qualify and have not yet received a loan can still apply. Under recently-approved legislation, the timeline for using the funds was extended to six months and the portion that has to be used for payroll costs was reduced to 60%, making it easier to qualify for full loan forgiveness. 

The Federal Reserve asked for feedback on a change to the Main Street loan program that would make loans available to 501(c)(3) and 501(c)(19) organizations with 50 to 15,000 employees. The Federal Reserve did not propose to include 501(c)(6)s or nonprofits with endowments larger than $3 billion. Feedback on the proposals are due June 22. 

In addition, the Small Business Administration (SBA) announced that the Economic Injury Disaster Loan (EIDL) and EIDL Advance programs will reopen to accept new applications from all eligible small businesses and agricultural businesses. EIDL applicants who have already submitted applications will continue to be processed on a first come first served basis.

Tomorrow’s CLA webinar will provide a tool for helping to navigate the required reporting that accompanies receipt of federal relief.

LeadingAge Clarifies Telehealth Visits for Comprehensive Assessments

On June 10, the Centers for Medicare & Medicaid Services (CMS) released a Frequently Asked Questions (FAQ) for Non-Long Term Care Facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IIDs). The purpose of the document is to clarify existing guidance and flexibilities for these non-LTC providers as well as to provide stakeholders with additional information based on questions CMS has received related to a variety of provider types. This article focuses on the general FAQs and those related to hospice providers.

LeadingAge's Mollie Gurian shared an article regarding hospices being able to utilize telehealth visits for comprehensive assessments.  Gurian clarified this with CMS, and it is noted in bold in the article.

House Coronavirus Oversight Committee to Launch Nursing Home Investigation

The House committee overseeing the federal response to the coronavirus crisis is launching an investigation into the country’s five largest for-profit nursing home companies, seeking details about their structure, executive compensation and preparedness for coronavirus. 

The Committee also sent a letter to the Centers for Medicare & Medicaid Services (CMS) criticizing the agency’s response to COVID. The panel is asking CMS for details about how it enforced health and safety regulations at nursing homes as the outbreak grew.

CDC/COCA Webinar Offers Key Directives

The Centers for Disease Control & Prevention (CDC) Clinical Outreach and Communication Activity (COCA) hosted a webinar entitled “Applying COVID-19 Infection Prevention and Control Strategies in Nursing Homes”. According to CDC, the information in this webinar is applicable to nursing homes, assisted living, and other long-term care facilities. The slides and recording for this webinar are available online.

A few key directives/highlights from this training:

• Facilities should designate one or more on-site staff to manage the infection prevention and control program (Infection preventionist).
• Program activities should include reporting into NHSN; educating staff, residents, and visitors about COVID-19 and facility infection control practices; implementing source control measures; creating plans for testing and for visitor restrictions; evaluating and managing health care personnel and residents with symptoms of COVID-19; maintaining supplies (hand hygiene, PPE, cleaning/disinfecting products), and implementing a respiratory protection program.
• Separate residents into COVID+, COVID-suspected, COVID exposed without symptoms (new admissions, observation stays, ER visits, etc.), and asymptomatic or presumed COVID-negative cohorts. Facilities should also have a space for observing new admissions whose COVID status is unknown. Designate staff and space for these cohorts.
• Minimize room moves. Do not move a resident into your COVID-positive space based on symptoms alone—get a positive test result first if possible. If a private room is available, a resident could be moved there while awaiting testing. Do not move the roommate of a pending resident.

QIO Program Nursing Home Training

The Quality Improvement Organization (QIO) program continues its weekly national nursing home training series.

Trainings are held every Thursday at 4:00 pm. This week’s subject is “Clinical Care: Managing COVID-Positive Residents.” Register for the training or access recordings of previous trainings online. This week’s session will also be recorded and available at the site. 

CDBG as Resource for Senior Housing COVID-19 Costs

Since March 27, state and local governments have received $3 billion of the CARES Act’s $5 billion for COVID-19 relief from HUD’s Community Development Block Grants (CDBG) program.

LeadingAge is hearing that some state and local governments, the receivers of these funds, are very eager for partners to help them efficiently and effectively use these dollars. Funds could be used for PPE, for meals and food, and for cleaning and disinfecting, among other uses. LeadingAge provided a link to an article about CDBG as a resource for senior housing COVID-19 costs.

LeadingAge members are encouraged to reach out to the state and local government agency contacts for these CDBG funds to identify possible partnership with addressing COVID-19 within affordable senior housing communities.

Hospice FAQs Give Guidance on Discharge

LeadingAge provided a link to an updated article on the new FAQs from the Centers for Medicare & Medicaid Services (CMS) related to hospice. Among the updates to the FAQs is new guidance that clarifies that hospices should only discharge patients if they have documented reasonable attempts and still have been unable to make a visit in person or using the telehealth waivers.

Affordable Housing Call Focuses on Staff Travel, Mental Health Considerations and More

In this morning’s weekly Housing Happenings call, LeadingAge staff provided insight on staff travel considerations and discussed three areas providers should consider:

• Know your state/federal employment laws;
• Ensure fairness and consistency when applying policies among staff; and
• Communicate policies and expectations clearly to all employees. 

To assist in travel decision-making, a LeadingAge Ohio task force created a tool for members on traveling and social gathering risk mitigation. Members can share this tool (Traveling and Social Gathering Risk Mitigation PDF ) with staff as summer travel plans are considered, or customize the tool to better fit the need of the organization (Traveling and Social Gathering Risk Mitigation - Word format ). In addition, LeadingAge has released a re-opening quickcast for housing providers available on the Learning Hub. 

In addition, Dr. Eric Berko, a clinical psychologist with Metro Health System in Cleveland, discussed the mental health challenges brought on by the pandemic and the need for empathy for staff, residents, and one's own self. Dr. Berko reviewed practical ways to combat the isolation, including utilizing telehealth and available online and community resources through local mental health boards. 

Join the weekly Affordable Housing COVID-19 Update and Discussion calls here.

Contacting FEMA for Problems with Nursing Homes

Nursing home providers who have concerns related to the FEMA PPE Packages – for example, not receiving a PPE package, receiving an amount that seems wrong, or receiving defective materials, can contact Federal Resources at www.federalresources.com or can call Customer Service at 1.800.892.1099.

LeadingAge Need to Know: COVID-19 – June 17, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured news about LeadingAge's new advocacy campaign titled 'Act for Older Adults'. 

Check out the full report here. 

Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook group to pose questions to peers and share best practices. LeadingAge is continuing its daily calls for all members.  To participate in these daily online updates, members should register at here.