September 16th

NYSHFA participated in a conference call today with the Governor’s Office and the Department of Health to review SNF visitation requirements announced in the September 15, 2020, Health Advisory.  Several updates were discussed including:

  • At this time, all visitors to nursing homes, meeting the criteria for visitation, are required to show a negative COVID test within 7 days, including for outside visits.
  • Documentation of the visitor’s COVID-19 test results can be noted on the existing visitor screening log sheet.
  • Visitors for residents at End of Life are exempt from the required showing a negative COVID test within 7 days.
  • The 7 day requirement starts from the date of the collection of the COVID test specimen.
  • Antigen Point of Care testing is not approved for use at the nursing home until the DOH releases guidance on use and reporting requirements.
  • The policy on the provision of salon services is currently under review.
  • Guidance for the policy of religious observation and visitation is currently under review is anticipated to be released soon.
  • Guidance for allowing visitation for individuals under the age of 18 years old is under review.

September 15th

On August 20, 2020, nursing home operators and administrators were advised, via DAL NH 2009 (“Required Annual Pandemic Emergency Plan for All Nursing Homes”), of the requirement to prepare and make available to the public on the facility’s website, and immediately upon request, a Pandemic Emergency Plan (PEP), pursuant to a recently-enacted statute, Public Health Law (PHL) section 2803(12). Specifically, the statute directs residential health care facilities to include in their PEP a plan “to maintain or contract to have at least a two-month [60day] supply of personal protective equipment” (emphasis added).

See attached DAL for further details….

09-15-2020 – Pandemic Emergency Plan (PEP)


Pandemic Emergency Plan (PEP) due today!

NYSHFA has been notified by the NYSDOH of the following as it relates to the posting of the Pandemic Emergency Plan (PEP).

The NYS statute is clear on the requirement that nursing home facilities must prepare a PEP and post the entire PEP (not parts of the PEP, or a summary statement) on the providers‘ website by September 15, 2020.

NYSHFA/NYSCAL CONTACTS:

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15


September 6th

Executive Order 202.60 Extended Until October 4, 2020

Executive Order 202.60 continues the declaration of the State Disaster Emergency effective March 7, 2020 as set forth in the Executive Order 202 for thirty days, to October 4, 2020.  Staff testing requirements for nursing homes and assisted living facilities are extended through October 4.

July 10th, 2020

NYSDOH SNF Visitation Guidelines

COVID-19 has been detected in multiple communities around New York State. Residents of NHs and ACFs are at especially high risk of severe morbidity and mortality. Healthcare personnel (HCP), other direct care providers and visitors who enter NHs and ACFs while symptomatic or asymptomatic with COVID-19 present a high risk for outbreaks. At this time NHs and ACFs statewide are required to take the following actions. This guidance supersedes previous NYSDOH guidance.


April 20th, 2020

NYSDOH DAL : Guidance for Resident and Family Communication in Adult Care Facilities and Nursing Homes

The New York State Department of Health recognizes that COVID-19 has presented unique challenges and has created a need for adult care facilities and nursing homes to develop innovative ways to keep residents connected to their families and communities.

Governor Cuomo recently signed two Executive Orders in relation to communication with family members. Executive Order 202.18 provides that any skilled nursing facility, nursing home, or adult care facility licensed and regulated by the Commissioner of Health shall notify family members or next of kin for all residents if any resident tests positive for COVID-19, or if any resident suffers a COVID-19 related death, within 24 hours of such positive test result or death. Financial penalties may be assessed for violations, pursuant to Executive Order 202.19.

NYSDOH – Advisory: Discontinuation of Isolation for Patients with COVID-19 Who Are Hospitalized or in Nursing Homes, Adult Care Homes, or Other Congregate Settings with Vulnerable Residents

Health Advisory: Discontinuation of Isolation for Patients with COVID-19 Who Are Hospitalized or in Nursing Homes, Adult Care Homes, or Other Congregate Settings with Vulnerable Residents…see attached

NYSDOH – DAL – Guidance for Nursing Homes on Managing Resident Deaths During the COVID-19 Outbreak

Due to the COVID-19 public health emergency, the New York State Department of Health (DOH) is distributing the following guidance to assist nursing homes in processing the removal of decedents. This guidance is intended for nursing homes that may be experiencing an increase in resident deaths, as well as nursing homes that may be relying upon new staff to perform this sensitive responsibility.


April 4th, 2020

COVID-19 Guidance Compilation for Long-Term Care (LTC)

The information in this compilation is current only as of the above date and time.

The purpose of this compilation is to provide long-term care providers in New York State with a consolidated list of guidance released by the New York State Department of Health (NYSDOH) related to the COVID-19 pandemic response.

National Emerging Special Pathogens Training & Education Center (NETEC) presents:

recorded on 3/27/20  |  recording length: 1hr 4min

This recorded webinar includes information on the extended use, reuse and innovative decontamination strategies for COVID-19 Personal Protective Equipment with a special focus on the process for decontamination and reuse of N95 filtering facepiece respirators using Ultraviolet Germicidal Irradiation (UVGI).

Best Practices, flow models and recommendations shared by experts from Emory University, the University of Nebraska Medical Center/Nebraska Medicine and the New York Health and Hospitals Corporation, Bellevue Hospital Center.

March 29th

NYSDOH – WEBINAR PPT – COVID-19 Infection Control Guidance for Nursing Homes and Adult Care Facilities

The information on the PowerPoint is current only as of the date of the presentation (unless otherwise noted).  The COVID-19 pandemic is rapidly evolving and for the latest numbers and/or guidance, please reference the links within the presentation.


March 23rd

NYSHFA | NYSCAL continues to have numerous discussions with the Governor’s office, the Department of Health (“DOH”) and AHCA/NCAL regarding many issues associated with the COVID-19 pandemic. Among the issues, we are working on are the following:

DOH Advisory to protect SNF Residents: Attached is an Advisory issued by the DOH with recommendations to Support Resident Physical Health and Support Resident Mental and Emotional Health

DFS Suspension of Preauthorization Requirements: Attached is a Guidance Document issued by the New York State Department of Financial Services suspending various Preauthorization and Review requirements. Here is the link to the guidance from NYS Department of Financial Services. Questions should be directed to Colleen Rumsey at colleen.rumsey@dfs.ny.gov.

Paid Leave for Orders of Quarantine: NYSHFA | NYSCAL has been working with the Governor’s office and the DOH to address the potentially significant negative staffing impacts of the Governor’s initiative to provide paid sick leave for any employee who is subject to a mandatory or precautionary order of quarantine or isolation.

CMS: Relief for Clinicians, Providers, and Facilities Participating in Quality Reporting Programs: CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to the 2019 Novel Coronavirus (COVID-19). You can find a copy of the press release here:  https://www.cms.gov/newsroom/press-releases/cms-announces-relief-clinicians-providers-hospitals-and-facilities-participating-quality-reporting

NYSHFA  |  NYSCAL Weekly Town Hall Calls for Members: We are listening to your requests to receive information as quickly as possible.  To meet that request, NYSHFA | NYSCAL has set up weekly Town Hall Calls to provide you information on key topics as well as, to offer you an opportunity to get questions answered and/or receive clarification. The weekly Town Hall Calls will start on Thursday, March 26, 2020 at 11:00am and will continue every Thursday at 11:00 am until further notice. Agendas listing topics will be sent at the beginning of each week.

New York State’s guidance for determining whether a business is subject to the workforce reduction requirements under Governor Cuomo’s Executive Orders.

Pursuant to this guidance, nursing homes, residential health care facilities and congregate care facilities and their employees, regardless of the nature of the service or the function they perform, are not subject to the Governor’s workforce reduction requirements.

CMS : Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19

CMS announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. The action comes as part of the Trump Administration’s response to 2019 Novel Coronavirus (COVID-19).

AHCA Interim Guidance: SNFs Accepting Admissions from Hospitals During COVID-19 Pandemic

The purpose of this document is to provide guidance to skilled nursing facilities (SNFs) to determine when making decisions about accepting hospital discharges to SNFs. The decision-making and guidance will likely change as the prevalence of COVID-19 varies in communities and hospital surge increases in the community.


March 22nd

Communicating After a Confirmed Case

It’s important to keep families and staff informed once you have confirmed a case of COVID-19 in your building. To help with communication to all stakeholders, AHCA/NCAL has developed a sample letter for families and staff and talking points for the media and broader public.

Making Decisions on Essential Staff Entering Your Building

When deciding if a person needs to enter your building (including employees or outside contractors such as therapy, pharmacy, lab, portable x-ray, mental health provider, repair technicians, and others), all long term care facilities should consider the intent of the federal and state guidance on visitation and building entry restrictions.

The intent is to restrict entry of as many people as possible to reduce the risk of COVID-19 entering and/or spreading in the building.  Anybody entering the building must comply with the most current federal and state COVID-19 guidelines. Entering multiple buildings during the day should be discouraged, or increased attention to infection control processes should be applied in cases when it is essential.

This decision needs to be balanced with meeting the needs of the resident. The risk-benefit trade off needs to be made on a case-by-case basis and should be informed by the high mortality associated with contracting this virus in the elderly. This decision process should also be evaluated and adjusted as necessary as the COVID-19 situation evolves in your local community and building.

Utilizing Non-Direct Care Staff to Support Needs

COVID-19 has interrupted usual daily operations in all long term care facilities. This means some direct or non-direct care staff usual duties are on hold or not urgent during this pandemic. Thus, there is opportunity to engage those staff in supporting activities that must continue despite the pandemic disruptions.  Below are some ideas to consider.

Typical Nurse Aide Duties to be Stopped and Shifted to Other Non-Direct Care Staff:

  • Deliver water and snacks
  • Deliver linen and supplies
  • Restocking supplies
  • Assisting residents in wheelchairs to/from events (bathing, etc.)
  • Take menu/orders from residents
  • 1-on-1 with resident who have behavioral challenges or need socialization
  • Deliver meals to residents during mealtime
  • Applying/removing glasses and hearing aids to residents
  • Bed making
  • Responding to call lights
  • Assisting with feeding non-choking or non-aspiration risk residents
  • Doing errands for the resident
  • Doing personal care such as combing hair or washing faces/hands
  • Stay with resident while in the bathroom to free up NA to do other tasks while waiting to transfer

Nurse and Nurse Aide duties that could be supported by physical and occupational therapy and speech-language pathology staff: 

  • Restorative and functional ADL and mobility maintenance services
  • Perform and document routine vital signs, orthostatic BPs, etc.
  • Assisting to feed moderate risk residents (history of some choking issues)
  • Any other basic support duties that could also be performed by non-direct-care staff

Typical Nurse (or some medication aide) duties to be shifted, stopped, or requests to reduce/discontinue: 

  • Request discontinue of non-critical medications (e.g. vitamins, calcium)
  • Request discontinue or reduced blood sugar checks (e.g. decrease to daily or weekly)
  • Request discharge of sliding scale insulin and standard/set amount of long-acting insulin administered every day
  • Request to reduce dressing changes to daily or biweekly (as appropriate)
  • Routine vital signs decrease to weekly or monthly (as appropriate)
  • Orthostatic B/Ps – reduce to one time daily or weekly (as appropriate)
  • Stop routine monthly vital signs

March 18th

CDC – PPEs Guidance »

CMS Issues Guidance Expanding Telehealth

Yesterday, CMS expanded telehealth for Medicare. Medicare will temporarily pay clinicians to provide telehealth services for beneficiaries for a wider range of services. CMS Under the new waiver, Medicare can pay for office, hospital, and other telehealth visits. For the duration of the COVID-19 Public health Emergency, Medicare will make payment for professional services to beneficiaries in all areas of the country in all settings.

If you do not currently have telehealth arrangements, you may want to explore such arrangements, but it also may not be technically possible and necessary depending on your facility, physician coverage, or other circumstances.

CMS Waives 3-Day Stay for Admission and for SNF Long-Stay Residents

On March 14, CMS issued a nationwide waiver of the 3-Day Stay requirement. This waiver means that SNF care will be covered by Medicare without a 3-day inpatient hospital stay required. CMS has told us that this applies to all Medicare beneficiaries during this national emergency, regardless of diagnoses or relationship to the coronavirus, however, CMS has not provided written specifics on this.

AHCA has created this FAQ to help address your questions.

Additional Waivers Available

CMS has also authorized certain Medicaid flexibilities; their FAQ on this is available here.

On March 17, CMS released the first Medicaid Section 1135 to the State of Florida. The waiver focuses exclusively on Medicaid and has no direct impacts on Medicare. AHCA/NCAL has created an overview of this waiver.


March 15th

EMERGENCY FACT SHEET & BLANKET WAIVERS

The Federal Government is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers combat and contain the spread of 2019 Novel Coronavirus Disease (COVID-19). The U.S. Centers for Medicare & Medicaid Services (CMMS) is empowered to take proactive steps through 1135 waivers.

COVID-19 Emergency Declaration Health Care Providers Fact Sheet:

https://www.cms.gov/files/document/covid19-emergency-declaration-health-care-providers-fact-sheet.pdf

CMS – Blanket Waivers of Federal Laws:

https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page

March 14th

House Passes Relief Package, Goes to Senate

Following a declaration of a State of Emergency by the President yesterday, the Centers for Medicare and Medicaid Services (CMS) issued new guidance via a memorandum that is based on the newest recommendations from the Centers for Disease Control and Prevention (CDC). It directs nursing homes to significantly restrict visitors and nonessential personnel, as well as restrict communal activities inside nursing homes. All individuals other than essential health care staff and visits for end-of-life situations, should no longer enter skilled nursing facilities (SNFs) until further notice. Here’s a quick summary:
  • Restrict all visitors, volunteers and non-essential health care personnel (e.g., barbers) except for certain compassionate care situations, such as end-of-life situations. Facilities are expected to notify potential visitors to defer visitation until further notice (through signage, calls, letters, etc.).
  • Visits for end-of-life situations are to be handled on a case-by-case basis, include screening of the visitor, use of personal protective equipment (PPE) and hand hygiene by the visitor and limited access to the facility (resident’s room or location designated by the facility).
  • Cancel all group activities and communal dining.
  • Implement active screening of residents and health care personnel for respiratory symptoms including actively checking temperatures for a fever (all health care personnel at beginning of shift and residents at least daily).
    • Document absence of symptoms
    • Those with symptoms of a respiratory infection (fever, cough, shortness of breath, or sore throat) should not be permitted to enter the facility at any time (even in end-of-life situations).
  • Screen and monitor residents when visitors, staff or others report respiratory symptoms within 14 days of interacting with the residents.
  • Surveyors are allowed but if they have a fever or respiratory symptoms they should not enter.
    • Ombudsman should only be allowed in for compassionate situations AND if they don’t have a fever or respiratory symptoms.
  • Identify staff that work at multiple facilities and actively screen and restrict them appropriately.
  • Enforce sick leave policies for ill health care personnel that are non-punitive, flexible, and consistent with public health policies allowing ill health care personnel to stay home.
  • Some governors or public health officials may have orders about visitors. For Medicare and Medicaid-certified facilities, this new guidance supersedes governor and public health officials’ orders, unless the state-level orders go beyond this new guidance. Then CMS expects facilities to adhere to additional requirements imposed by the State or local authorities.
This new guidance means facilities need to explore mechanisms to allow family members, ombudsman, resident representatives, and others to communicate with the residents.
This new guidance should be used in place of AHCA’s visitor guidance released on March 9 (which has now been removed from our website).We are in the process of updating our existing documents and tools on the website to ensure they match the newest guidance. So, please keep checking AHCA/NCAL’s COVID-19 website.

ADDITIONAL IMPACTS FROM THE NATIONAL EMERGENCY DECLARATION

Three-Day Stay Waiver

The President announced during his press conference declaring a national emergency, that he was suspending the Medicare’s three-day stay requirement before a SNF admission. We have not yet seen anything in writing about this from CMS and will forward to you when we receive any more information.

CMS Releases MAC-by-MAC Medicare Part B COVID-19 Test Billing Rates

The Medicare claims processing systems will be able to accept HCPCS codes (U0001, U0002) starting on April 1, 2020, for dates of service on or after February 4, 2020. It is important to note that Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates. View a map of CMS MAC coverage and the MAC by MAC rates. For details on how to submit billing, please check your MAC websites and/or call their provider support number. The relevant CMS guidance is Medicare Coverage and Payment Related to COVID-19 and is located here.

MDS Completion and Submission Waivers

CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set (MDS) assessments and transmissions. CMS has not yet issued technical guidance on how to implement.

SNF Part A 100-Day Benefit Waiver

For “certain beneficiaries who recently exhausted their SNF benefits, the waiver authorizes renewed SNF coverage without first having to start a new benefit period”. CMS has not yet issued technical guidance on how to implement.

Provider Location for Billing Waiver

“Temporarily waive requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed in another state.” Note: this is for billing purposes and State licensing still needs to be followed. CMS has not yet issued technical guidance on how to implement.

HOUSE RELIEF PACKAGE

Separately, the House of Representatives passed a relief package late yesterday. It still must be passed in the Senate, but it includes a temporary 6.2% FMAP increase to state Medicaid programs, paid sick leave for employers with 500 employees or less, tax credits, and funding for certain tests. We will continue to monitor this legislation and keep you posted about possible implementation.


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