May 26th, 2020

AHCA/NCAL UPDATE #71

CARES Attestation Window Extended, Updated Guidance & Financial Resources

On Friday May 22, U.S. Department of Health and Human Services (HHS) extended the CARES Act Provider Relief Fund attestation window. This allows time to address additional questions and to offer providers time to collect necessary payment portal information. In the press statement, HHS announces that the attestation window and related acceptance of Terms and Conditions has been extended from 45 to 90 days from the date a provider received a payment to attest to and accept the Terms and Conditions or return the funds. Providers should have received emailed letters from HHS on Friday. Providers should have received emailed letters from HHS on Friday.

Members will need to identify the dates of each relief payment and identify their new attestation and Terms and Conditions acceptance date based on the extension. HHS updated the Fund FAQs twice this past week.

AHCA/NCAL has updated the COVID-Related Cost and Loss Calculator and prepared a guidance document on the CARES Act Provider Relief Fund (member login required for both resources). The guidance includes:

• Updated AHCA/NCAL CARES Act Provider Relief Fund FAQs;
• A merged version of Tranches 1 and 2 Terms and Conditions with easily identifiable changes as well as a redline version of the SNF Allocation Terms and Conditions showing differences relative to the Tranches 1 & 2 Terms and Conditions. SNF Allocation has its own Terms & Conditions. Each of the three versions of the T&C must be attested to using TINs and award dollar amounts; and
• A table containing key FAQs and AHCA/NCAL interpretations of HHS guidance.

Questions about Award Amounts

If you have questions or concerns about Tranches 1, 2, 3 awards, contact the HHS Hotline at (866) 569-3522. HHS reported on Friday that the call center now has access to additional data and new HHS guidance to better answer questions. When calling have the following information ready:

• TIN(s)
• CCN(s)
• Dollar Amount in question by tranche and by building

Also, if questions about Tranche 3, the SNF Allocation, also have the number of SNF certified beds (Medicare, Medicaid or both) as well as the amount you received and the amount you believe you should have received.

For Tranches 1 and 2, in its May 14 FAQ update, HHS provided an explanation of why a building might not have received a Tranche 2 allocation. The FAQ provides a formula and explanation of how a Tranche 1 award may have impacted eligibility for Tranche 2. See FAQs on page 7 of the updated FAQ document. HHS added Change in Ownership (CHOW) FAQs as well as TIN FAQs. The latter FAQs are called out in the AHCA/NCAL Guidance document in addition to inclusion in the HHS FAQs.

Next Steps – Additional CHOW, TIN, and Other Questions

AHCA/NCAL will continue to submit questions and examples of challenging fund scenarios to HHS including CHOW, TIN aggregation, disaggregation, and additional questions about financial terminology and use of tax filing data for validation. However, HHS has verbally indicated the Department’s goal is “maximum flexibility.” While we will continue work with them during the additional assentation window time, it is possible they will defer to reconciliation and reporting documentation to address all scenarios.

Updated NCAL Guidance on Reporting in Assisted Living Communities

NCAL has updated guidance on notifications and reporting confirmed cases of COVID-19 in assisted living communities. NCAL encourages all assisted living communities to follow state and local requirements for reporting. Providers should use documented reporting information when reaching out to local county and state health departments when requesting assistance for supplies, such as personal protective equipment.

NHSN Update and FAQs

Nursing facilities were required to submit their first set of data to NHSN by 11:59 pm on May 17, 2020 to be compliant with the new requirements . Facilities may choose to report more frequently, but at minimum must report at least once every seven days. The initial two-week grace period ends at 11:59 pm on May 24, 2020. Facilities that fail to begin reporting after the third week, ending at 11:59 pm on May 31, will receive a warning letter reminding them to begin reporting the required information to CDC/NHSN. Facilities who have not started reporting in the NHSN system by 11:59 pm on June 7th, ending the fourth week of reporting, CMS will impose a per day (PD) CMP of $1,000 for one day for the failure to report that week. Each subsequent week that the facility fails to report will result in an additional one day PD CMP imposed at an amount increased by $500.

NHSN updated the instructions for the pathway forms on May 12. When completing the data collection and upload, be sure that you are using the most current instructions . You can find the new instructions on the NHSN website. During one of the NHSN data reporting webinars, the NHSN team identified that each item question must have an answer entered or it will be counted as missing data and it will be counted as not being reported. When you enter count data, even if the answer is nothing or zero, you must enter 0 in the data field. If you leave it empty, it will be flagged as “no answer”.

According to the CDC, “to maintain consistency in reporting, if a facility is using crisis level strategies” the facility is experiencing a shortage. “In other words, PPE strategies that do not commensurate with U.S. standards of care are considered as a shortage. For information in relation to CDC’s optimization strategies for PPE (standard, conventional, and crisis), we encourage facilities to refer to Optimize PPE Supply website.

A center can easily identify if they are missing data in the NSHN module by reviewing the calendar view page. Any pathway that is incomplete will be highlighted as a tan color. Pathways highlighted as green indicated all questions were answered. Missing pathway means the pathway has not been started. As of right now, NHSN does not send notices for incomplete data. Centers are encouraged to review the calendar view to ensure all four pathways are highlighted in green to ensure compliance with reporting to NHSN.

Centers are continuing to report a delay in being able to register and upload data to NHSN. There are also centers who are reporting significant delays in having their questions answered via NHSN help desk. Centers who are experiencing delays are encouraged to keep documentation of all attempts of contacting NHSN and any communications you have with them.

Some centers are reporting that they are not receiving the Agreement to Participate and Consent email. If this is happening to your center and you do not receive the Agreement to Participate and Consent in your inbox for whatever reason, you should follow these instructions:

1. Log-in to SAMS.
2. Select Long-term Care Facility Component and your facility/group name.
3. Click “Submit” to review the “Agreement to Participate and Consent”.
4. Click ‘Accept’ next to the appropriate contact name.
5. Click “Submit”. A pop-up notification will appear confirming this action.
6. Click “ok” to acknowledge the notification.

If you log in to SAMS and see the “Annual Survey” alert on your facility homepage, you should follow these steps to remove the alert:

1. On the facility homepage, click “Survey Required 2020” alert on the facility homepage to be directed to the online survey
2. Complete the “Facility Characteristics” section and scroll to the bottom to click “save” to submit your survey.

CDC Posts NHSN Training Recording and Offers Webinar for Groups

The COVID-19 Module Overview for Long-term Care Facilities recorded video presentation and slideset are now available on the COVID-19 LTCF Module webpage, as well as COVID-19 Module Enrollment Guidance for LTCF under Training.

Senate Hearing on Caring for Seniors Amid the Coivd-19 Crisis

On Thursday, May 21, U.S. Senate Special Committee on Aging Committee held a hearing entitled, “Caring for Seniors Amid the COVID-19 Crisis .” The hearing featured three non-governmental witnesses that discussed how COVID-19 is affecting seniors, especially seniors receiving care in skilled nursing facilities, as well as other topics including personal protective equipment, infection control, data collection, regular testing of residents and staff, pandemic health care provider funding, and vaccines and treatments.

AHCA/NCAL submitted a statement for the record. You can watch a video recording of the hearing, and read the majority and minority press statements of the U.S. Senate Aging Chairman and Ranking Member.

May 24th, 2020

New York State Medicaid Billing Guidance for COVID-19 Testing and Specimen Collection

NYSDOH distributed this memorandum late yesterday. They noted that the services in this guidance document related to COVID-19  and specimen collection are currently reimbursable by NYS Medicaid fee-for service and Medicaid Managed Care (MMC) Plans. See attached for full information.

• 05-24-2020 – NYSDOH – COVID-19 Testing Guidance with Provider Specimen Collection

May 23rd, 2020

NYS Medicaid Guidance for COVID-19 Testing at Pharmacies and Specimen Collection

The Department of Health has issued the following policy and billing guidance documents regarding testing of the COVID-19 virus:

• New York State (NYS) Medicaid Fee-for- Service (FFS) Policy and Billing Guidance for COVID-19 Testing at Pharmacies
• New York State Medicaid Billing Guidance for COVID-19 Testing and Specimen Collection

These documents will also be available on the COVID-19 Guidance for Medicaid Providers webpage, which is updated regularly with guidance and information.

May 19th, 2020

NYSHFA/NYSCAL participated on a call tonight with the Department of Health on instruction on completing the Survey released tonight. Nursing Homes and Assisted Living are required to complete the survey once each week.  The Survey questions request retrospective and future numbers pertaining to staff testing, tests kits, and lab receiving test specimens. The first Survey must be completed and submitted by Thursday May 21, 2020 by 5:00pm for designated time frames.

The survey has a separate URL link and is not found on HERDS. The current HERDS daily survey will remain in place to collect daily information on non-testing questions such as PPE and COVID positive residents

https://apps.health.ny.gov/pubpal/builder/survey/nursing-home-testing

NYSDOH – Executive Order 202.30 – Nursing Home and Adult Care Facility Staff Testing Requirement FAQ Update

Following the Executive Order 202.30 mandating staff testing for all personnel at nursing home and adult care facilities, the Department released the attached set of answers to providers’ most Frequently Asked Questions on testing staff including but not limited to who must be tested, what are the acceptable types of tests, how to handle and report staff with positive test results and who is responsible to pay for the tests.

https://coronavirus.health.ny.gov/system/files/documents/2020/05/doh_covid19_nursing_home_acf_staff_testing_faq_may192020.pdf

AHCA/NCAL – #69

Reimbursement and Legal Issues Related to COVID-19 Testing in Long Term Care

We have received many questions from members on reimbursement and legal issues related to COVID-19 testing in LTC.  Responses to common member questions are included below:

Reimbursement Issues

Medicare Coverage of Testing: Medicare fee for service and Medicare Advantage plans will cover the cost of COVID-19 diagnostic (PCR) tests. Tests range in cost from $115 to $500.  Medicare Part B will only reimburse approximate $100 for the PCR and $35 for other tests. However, not all labs will bill Medicare directly. AHCA/NCAL strongly recommends that, wherever possible, providers use labs that will bill Medicare, as providers may not be able to bill for these services.

CARES Act Coverage: The CARES Act requires health plans to cover the cost of COVID-19 testing for beneficiaries at no cost to the beneficiary. CMS is requiring Medicare Advantage Plans to cover the costs of testing for MA plan beneficiaries. Typically, however, when a test is required by an employer for employment, then the employer is responsible for the cost of the test. If the state is mandating testing the employer may not be held accountable for the cost of the test but this has not yet been validated.

CARES Act Grant Funds: The CARES Act Grant Funds can be used to cover costs for resident tests that are not otherwise reimbursable. This does NOT include testing for residents under a Part A stay where it is included in consolidated billing.

Legal Issues

Resident Refusals: Residents that refuse to be tested for COVID-19 cannot be discharged involuntarily, unless the facility is otherwise incapable of caring for residents with a confirmed diagnosis of COVID-19.

Employee Refusals: Employers can make COVID-19 testing a condition of employment and terminate or not hire a person who refuses to obtain a COVID-19 test.

For more information, please review the reimbursement and legal section of AHCA/NCAL’s Preparing for Widespread Testing in LTC Guidance.

May 18th, 2020

The Centers for Medicare & Medicaid Services (CMS) …

is committed to taking critical steps to ensure America’s nursing homes are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).  On May 18, 2020, CMS announced new guidance for state and local officials to ensure the safe reopening of nursing homes across the country.

1. CMS Nursing Home Reopening Recommendations Frequently Asked Questions

CMS released the FAQ document with answers to a range of questions on the topics of: • Reopening  • Visitation • Testing Requirements

• FAQ covid-nursing-home-reopening-recommendation-faqs

1. CMS QSO Guidance for the Recommendations on Nursing Home Reopening

Given the critical importance in limiting COVID-19 exposure in nursing homes, decisions on relaxing restrictions should be made with careful review of a number of facility-level, community, and State factors/orders, and in collaboration with State and/or local health officials and nursing homes. State and local leaders will regularly monitor the factors for reopening of nursing homes and adjust their plans accordingly. The reopening phases included in the QSO cross-walk the phases of the plan and includes efforts to maintain rigorous infection prevention and control, as well as resident social engagements and quality of life.

1. Press Release
2. CMS nursing-home-reopening-recommendations-state-and-local-officials FAQ covid-nursing-home-reopening-recommendation-faqs doh_covid19_nursing_home_acf_staff_testing_faq_may192020

AHCA/NCAL – #68

NYSDOH released a Notification today in response to facility feedback on the recent survey concerning Executive Order (EO) #202.30

NYSDOH released a Notification today in response to facility feedback on the recent survey concerning Executive Order (EO) #202.30 regarding staff testing and the concern about available laboratory capacity for SARS-CoV-2 molecular testing (diagnostic testing), New York State has reserved capacity at several laboratories to assure that laboratory services will not be a barrier to nursing home and adult care facilities compliance with the EO.

New York State has matched facilities with potential laboratory partners based on geographic and prior relationship considerations, which are outlined in the attached document. Please note that designated laboratories are merely identified to facilitate the testing needs. If you have already obtained sufficient lab testing capacity, please let us know as soon as possible. Facilities may continue to explore and utilize other laboratories at their own discretion and please inform us if you discontinue. Further, it is the responsibility of the nursing home or adult care facility to connect with the laboratory to discuss the specific needs of your facility and to make billing arrangements. Please use the contact information below.

• 05-18-2020 – NYSDOH –  Lab Availability Listed by County

Quest Diagnostics

Amy Pisone   |   Amy.R.Pisone@questdiagnostics.com

Boston Heart Diagnostics

Alex Abramov   |  M: 201-919-5115   |   AAbramov@BostonHeartDx.com

BioReference

Susan Faccone   |    M: 201-819-7191   |   O: 800-229-5227  x7427   |   sfaccone@bioreference.com

Lenco

Dennis Tilman   |    M:  718.757.7117   |  O: 718.232.1515 x111

Northwell

Mike Eller    |   516.286.3292   |   Meller@northwell.edu

Lab Corp

Alissa S. Farrier   |   M: 518-321-1932   |   farriea@labcorp.com

Should you have any questions, please contact nursinghometesting@health.ny.gov or the Nursing Home Assistance and Coordination Center at (518) 474-6512.

May 17th, 2020

A Note from Our CEO & President

Following a call with the Governor’s office Sunday evening, NYSHFA/NYSCAL anticipates the State sending every nursing home and adult care facility on Monday, May 18^th the name(s) of labs that have the capacity in the facility’s region to conduct COVID-19 tests twice a week for all respective facility staff. Additionally, it is anticipated the State will require new signed certifications from those administrators/operators that submitted modified certifications on Friday, May 15^th by COB Monday, May 18^th. While legally it is of little consolation, the Governor’s office did acknowledge that a signed certification does not mean that every aspect of every operation is always in 100% compliance, but that all required executive orders, policies, procedures and guidelines are diligently being followed by providers. The State is also working to have the twice a week COVID-19 tests deemed “medically necessary” so as to be covered by commercial insurance pursuant to the CARES Act. While the current executive order expires June 9^th, the State indicated that it will be reviewing its twice a week employee testing mandate on a weekly basis in an effort to determine how long it’s mandate will be in place.

NYSDOH issued a Health Advisory providing Authorization of Licensed Pharmacists to order COVID-19 Tests on May 15 2020.

Executive Order 202.24, issued on April 25, 2020, authorizes licensed pharmacists to order COVID-19 tests, approved by the Food and Drug Administration (FDA), to detect SARS-CoV-2 or its antibodies.  Executive Order 202.24 also allowed pharmacists to administer COVID-19 tests subject to subdivision 579(3) of the Public Health Law, in patients suspected of a COVID19 infection, or suspected of having recovered from COVID-19 infection, subject to completion of appropriate training developed by the Department of Health (NYSDOH). Pharmacies wanting to perform COVID-19 testing, must apply and be approved as a limited service laboratory (LSL

• 5-17-2020 – NYSDOH – Authorization of Licensed Pharmacists to order COVID-19 Tests

This NYSDOH Health Advisory contains the May 15 2020 Dear Administrator Letter (DAL) providing guidance for Novel Coronavirus Disease (COVID-19) Specimen Collection Training for Unlicensed Individuals.  Attached are the PowerPoint slides noted in the DAL for the COVID19 Diagnostic sampling training program, located on the Health Commerce System (HCS).

• 05-17-2020 – NYSDOH – Specimen Collection Training for Unlicensed Individuals
• 05-17-2020 – NYSDOH – COVID19_Diagnostic_Sampling_Training

May 16th, 2020

NHSN Enrollment Webinar Slides have been Posted

Yesterday, the National Health Care Safety Network (NHSN) held an additional webinar for Long Term Care COVID-19 Enrollment. It reviewed the 3-step process to enroll into the NHSN, the Secure Access Management Services (SAMS) and then to enter your facility (facilities). You can find the new educational program materials at: https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/covid19-enroll-refresh-508.pdf. CDC will also post their audio webinar within a couple days if you prefer to listen to the session provided on Friday, May 15 at 3 pm.

The NHSN emphasized that the first two stages of the enrollment process may take between 3-5 days to process. The first two steps require providers to agree to a certification process and then providers receive a ticket from CDC/NHSN to be able to progress to the next step. Therefore, if you have not started this process yet, you must begin asap to meet the deadlines of data submission.

As noted in previous NYSHFA/NYSCAL Priority Alerts, the first data upload is due by May 17, 2020, but does have a grace period to May 24, 2020. The NHSN is processing provider registrations and enrollments seven days a week to accomplish the deadline requirements.

NHSN is answering emails for assistance as fast as possible and requests that providers do not send in the same request multiple times, as this is dramatically slowing down the ability to respond.

The NHSN educational materials will guide you through the process.

NYSDOH Health Advisory: Nursing Home Cohorting FAQs

Please review the attached, “Health Advisory: Nursing Home Cohorting FAQs.”

For questions, please send an e-mail to nursinghometesting@health.ny.gov.

May 14th, 2020

NYSHFA/NYSCAL is actively working on numerous issues related to the COVID-19 pandemic impacting providers, including the following:

1. Funding for COVID-19 costs: There is $100B still available at the federal level to support this pandemic. AHCA actively seeking $10B for Skilled Nursing Facilities (SNF) to help offset the significant COVID-19 expenses and loss of revenue. Money is expected to be distributed as early as the end of this week. This will be an initial payment to facilities. Then as specific SNF data is uploaded to CDC’s National Health Care Safety Network (NHSN), they will determine payments based on the numbers of COVID-19 cases and their estimate of costs. AHCA is also identifying the future financial support needed to meet ongoing infection control issues.
2. Administrator/Operator Owner Certificate of Compliance:  EO 202.30 directs the LNHA and the Owner/Operator of each SNF to sign a Certificate of Compliance by Friday, May 15, 2020. NYSHFA, with legal Counsel, is sending out in a separate e-mail sample Administrator/Operator Certification of Compliance language you may wish to consider replacing the current Department of Health Administrator/Operator Certification of Compliance language with the attached sample in its entirety when responding to the Friday, May 15th DOH requirement regarding compliance with E.O. 202.30 and all DOH directives.
3. Research on COVID-19: AHCA also has been in contact with Harvard and Brown Universities who have been researching any correlation between potential poor care in SNF and outbreaks of COVID-19. Their research is not demonstrating this type of correlation. It is, however, demonstrating a correlation between the community an individual live in and the volume of individuals who live in communities. The higher the number of individuals living in a community, the higher levels of COVID-19
4. Family Visitation: AHCA is working on a plan with steps/phases to safely open resident visitation and will be working with CMS on this initiative.
5. Testing: AHCA ‘s May 12, 2020 Update # 66, provides clear descriptions of the types of tests available and provides recommendations for COVID-19 testing. AHCA recommends providers use PCR tests to diagnose active COVID-19 infection by detecting the RNA genetic material in the COVID-19 virus. PCR tests are collected though a nasal or throat swab and the testing of the specimen is usually done in a lab (with the exception of several point of care devices on the market). DOH noted today, on their infection control webinar, that PCR testing is the most valid test for detecting the active COVID-19 virus.

CONTRACTOR INFORMATION FOR NYC 5 Boroughs

CONTRACTOR INFORMATION FOR MARO NORTHERN (Lower Hudson, Mid Hudson)

CONTRACTOR INFORMATION FOR WESTERN NY

CONTRACTOR INFORMATION FOR CAPITAL REGION NY

NYSDOH – HEALTH ADVISORY: PEDIATRIC MULTI-SYSTEM INFLAMMATORY SYNDROME TEMPORALLY ASSOCIATED WITH COVID-19INTERIMCASE DEFINITION IN NEW YORK STATE

• 5-14-2020 – NYSDOH – Pediatric Multi-System Inflmmatory Sydrome

May 13th, 2020

FAQs – Executive Order 202.30 – Nursing Home and Adult Care Facility Staff Testing Requirement

• 05-13-2020 – Frequently Asked Questions for NH/ACF Testing

CMS Issues Nursing Homes Best Practices Toolkit to Combat COVID-19

New tool provides innovative solutions for states and facilities to protect our nation’s vulnerable nursing home residents during emergency

Today, under the direction of President Trump, CMS released a new toolkit developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities, with additional resources to aid in the fight against the coronavirus disease 2019 (COVID-19) pandemic within nursing homes. The toolkit builds upon previous actions taken by the Centers for Medicare & Medicaid Services (CMS), which provide a wide range of tools and guidance to states, healthcare providers and others during the public health emergency. The toolkit is comprised of best practices from a variety of front line health care providers, Governors’ COVID-19 task forces, associations and other organizations, and experts, and is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.

“The coronavirus presents a unique challenge for nursing homes. CMS is using every tool at our disposal to protect our nation’s most vulnerable citizens and aid the facilities that care for them. This toolkit will support state, local leaders and nursing homes in identifying best practices to protect our vulnerable elderly in nursing homes” said CMS Administrator Seema Verma.

The toolkit provides detailed resources and direction for quality improvement assistance and can help in the creation and implementation of strategies and interventions intended to manage and prevent the spread of COVID-19 within nursing homes. The toolkit outlines best practices for a variety of subjects ranging from infection control to workforce and staffing. It also provides contact information for organizations who stand ready to assist with the unique challenges posed by caring for individuals in long-term care settings. Each state was involved in the creation of this toolkit, resulting in a robust resource that may be leveraged by a variety of entities serving this vulnerable population.

Additionally, CMS has contracted with 12 Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to work with providers, community partners, beneficiaries and caregivers on data-driven quality improvement initiatives designed to improve the quality of care for beneficiaries across the United States. The QIN-QIOs are reaching out to nursing homes across the country to provide virtual technical assistance for homes that have an opportunity for improvement based on an analysis of previous citations for infection control deficiencies using publicly available data found on Nursing Home Compare.

This effort augments CMS Administrator Seema Verma’s five-part plan to ensure safety and quality in America’s nursing homes, which was announced in April 2019, and recent agency efforts to combat the spread of COVID-19 within these facilities. Since February, CMS has taken unprecedented action to address COVID-19 within nursing homes. On February 6, CMS took action to prepare the United States for COVID-19 by reissuing longstanding infection control guidelines. CMS then moved quickly to address the rapid spread of infection by issuing guidance on new screening processes for facilities, on the use of personal protective equipment (PPE), and on temporary restrictions on non-essential medical staff and visitors in March. CMS immediately followed these actions by prioritizing inspections to conduct targeted surveys for infection control and complaints triaged at the Immediate Jeopardy level.

The Agency also issued a call to action for nursing homes and state and local governments as a means of reinforcing infection control responsibilities and urging leaders to work closely with facilities to determine needs for testing and PPE. Recently, CMS announced payment increases for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers of COVID-19 cases. Finally, CMS will now require nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC) and inform residents and their families and representatives of COVID-19 cases within their facilities in an effort to improve transparency.

May 12th, 2020

NYSDOH announced that they are preparing to release a new HERDS survey today. This new Survey will provide information to assist SNF and ACF’s providers with the development of a testing plan for all facility staff to meet the Governor’s Executive Order 202.30. The HERDS survey will be posted on the Health Alert Network and NYSHFA will distribute a copy once it is posted.

May 11th, 2020

Required COVID-19 Testing for all Nursing Home and Adult Care Facility Personnel/Hospital Discharge Alert

On May 10, 2020, Governor Andrew M. Cuomo signed Executive Order (“EO”) 202.30, which requires periodic COVID-19 testing of all personnel in nursing homes and adult care facilities. This DAL explains the requirements of the Executive Order and provides additional direction and guidance on how to implement its requirements. See attached DAL.

• 05-11-2020–NYSDOH – DAL_TESTING ACF

Dear Adult Care Facility and Nursing Home Administrators and Leadership:

Per Executive Order 202.30 (attached) all NYS ACFs and NHs are required to submit a plan, by May 13, 2020, to assure all staff are tested for COVID-19.

A survey has been developed in the HERDS application on the Health Commerce System. Submission of this survey is due by 5pm on May 13, 2020 and constitutes submission of your facility COVID-19 testing plan.

The name of the survey activity is: “COVID-19 Testing Plan.  The is a form to be used by ACFs and a form to be used for NHs when you select the survey activity under Data Entry.

Please be sure that when staff complete the survey that they save and SUBMIT the survey. Unless the survey is submitted the NYSDOH cannot see your responses in HERDS reports and CANNOT credit your survey as completed.

For questions, please send email to: nursinghometesting@health.ny.gov

• 05-11-2020 – NY Gov Cuomo Exec Order 202.30 

Letter From CMS Administrator to Nursing Home Workers

Today, the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma penned a letter to nursing home management and staff. Administrator Verma shared her gratitude for the unwavering dedication and commitment of nursing home management and staff in keeping residents safe and for continuing to compassionately care for those who rely on them during this unprecedented time. The letter also provides links to previously shared infection control resources.

Click for CMS Letter

May 10th, 2020

Nursing Home Assistance and Coordination Center (NHACC)

The New York State Department of Health (DOH) recognizes that COVID-19 has presented unique challenges for nursing homes. In order to provide additional support to nursing home residents, DOH has created the Nursing Home Assistance and Coordination Center (NHACC). The NHACC has been established during the pandemic to respond to urgent requests from nursing homes statewide. The NHACC staff will assist nursing homes in identifying solutions through a dedicated toll-free number. See full DAL attached.

UPDATED: NYS Health Facilities Association Statement on Governor Cuomo’s New Policy for Nursing Homes

• Calls on HHS to fulfill request by long term care industry for emergency funding to pay for expanded testing, PPE equipment and staffing
• Requests New York State help expand availability and access to testing via state’s National Guard or other means in short-term

• Download NYSHFA Press Statement 5.11.20.

NYSDOH Requiring Immediate Action of Nursing Homes by Sunday May 10 at 4 pm

SKILLED NURSING FACILITIES ONLY IN THE FOLLOWING COUNTIES:

Allegany – Bronx – Cattaraugus – Cayuga – Clinton – Erie – Genesee – Herkimer – Kings – Monroe – Nassau – New York – Niagara – Oneida – Oswego – Otsego – Queens – Richmond – Rockland – Saratoga – Suffolk – Sullivan – Tioga – Wayne – Yates

In order to expedite the testing of staff for COVID-19, please submit the information emailed, which is needed to obtain the contact information for your staff. This information will allow the Department of Health to help arrange for testing for your staff for COVID-19 testing at the numerous sites around the state. This information request is authorized under New York State Public Health Law Section 2803(a) and Title 10 of the New York Codes, Rules and Regulations Sections 415.19 and 415.30(g)

The DAL was only sent to the specific counties listed as target areas. Facilities in these areas should have received the Alert/DAL with an attached excel spreadsheet to complete regarding your facility staff (agency staff is to be included on this sheet).

The due date for the data is Sunday, May 10 at 4:00 pm and submitted to nursinghometesting@health.ny.gov

Questions regarding the completion of the excel spread sheet or the Alert/DAL please contactvalerie.deetz@health.ny.gov

May 8th, 2020

#64 – AHCA/NCAL

CDC – NHSN Enrollment Delays & Tips

It is taking longer than anticipated for nursing homes to enroll in CDC’s National Healthcare Safety Network (NHSN) due to high demand from the new CMS reporting requirements. The NHSN have recruited additional staff to reduce the processing time of enrollment requests.

Access detailed registration instructions for new facilities. Facilities are encouraged to review the Enrollment Guidance document for a more in-depth explanation of the enrollment process. Nursing homes should keep documentation of efforts made to enroll in NHSN. 

IMPORTANT NOTE: For the best experience and quicker access to the system, please be sure you are replying to a registration/enrollment email. Emailing the NHSN user support helpdesk will result in longer wait times for a reply.

Additionally, NHSN is providing two live Zoom sessions to address enrollment specific questions. After registering, you will receive a confirmation email containing information about joining the meeting.
LTCFs COVID-19 Live Q&A Session for Module and Enrollment Specific Questions 
Tuesday, May 12, 2020
1:00 PM (Eastern time)
Register

Thursday, May 14, 2020
2:00 PM (Eastern Time)
Register

PPE Supplier List

Knowing whether a Personal Protective Equipment (PPE) supplier is reliable is challenging these days with all the pop-up PPE suppliers and PPE scams. To assist members, AHCA/NCAL has developed a list of PPE suppliers that have recently served long term care providers . The list is not an endorsement or seal of approval of any particular PPE supplier, but can be used as a resource when PPE is not available through their ordinary supply chains.

Members should keep in mind that PPE demand currently far exceeds PPE supply. Suppliers are facing unprecedented challenges obtaining PPE, so the suppliers on this list may not have PPE at the time they are contacted. These PPE suppliers are doing their best to fill orders as PPE shipments arrive or their PPE is manufactured. If a supplier is out of stock, ask when to check back.

This list will be updated as more PPE suppliers are identified that have successfully delivered PPE supplies to AHCA/NCAL members during the pandemic.

NETEC – Webinar on PPE Use Next Week

The National Emerging Special Pathogens Training and Education Center (NETEC) is hosting a town hall forum next week to answer frequently asked questions surrounding the use of Personal Protective Equipment in the care of COVID-19 patients. See how to register online below.
NETEC Webinar: PPE! You’ve Got Questions. We’ve Got Answers.
Wednesday, May 13, 2020
12:00 pm ET
Register

May 7th, 2020

NYSHFA | NYSCAL TOWN HALL CALL

11:00am – 11:30am

Contact Melony Spock for login details at mspock@nyshfa.org

#62 – AHCA/NCAL

CMS Releases Memo on Interim Final Rule Updating Requirements for Reporting and Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes

Late today, CMS released a QSO memo addressing the Interim Final Rule requiring nursing homes to report to NHSN on COVID-19 as well as provide notifications to residents, their representatives and families.

Some highlights from the memo are listed below. AHCA is reviewing the information and will issue additional updates with further details and tools to help members comply.  There are some important implementation dates members need to know.

These requirements go into effect with the publication in the Federal Register of the interim final rule on May 8, 2020.  

CMS had previously communicated the effective date was May 1. However, CMS revised the effective date to be May 8, 2020.

• The effective date means nursing homes are required to begin notifications of residents, their representatives and families as of May 8. This means the first notification could be required to occur by May 9 at 5 pm, should the facility have any of the resident and/or staff cases on May 8 as described by CMS required to make notification.
• Action: Ensure system and processes for notifications are in place in your facility by May 8 to meet new requirements.

CMS – Facilities must submit their first set of data by 11:59 pm on Sunday, May 17, 2020 to the NHSN Long-Term Care Facility COVID-19 Module.

• Action: Register now for NHSN and begin collecting data starting May 8, 2020.  [NOTE: registration is taking more time than expected and we encourage you to start now to avoid further delays that may impact your compliance.]
  • The memo provides an overview of the registration process.
  • For NHSN questions, please email: NHSN@cdc.gov and add “LTCF” in the subject header.

CMS will provide facilities with an initial two-week grace period to begin reporting cases in the NHSN system (which ends at 11:59 p.m. on May 24, 2020).

Facilities that do not begin reporting after the third week (by 11:59 pm on May 31, 2020) will receive a warning letter reminding them to begin reporting the required information to the CDC.

For facilities that have not started reporting in the NHSN system by 11:59 p.m. on June 7, ending the fourth week of reporting, CMS will impose a per day (PD) CMP of $1,000 for the failure to report that week.

For each subsequent week that the facility fails to submit the required report, the noncompliance will result in an additional one-day PD CMP imposed at an amount increased by $500.

For enforcement-related questions, please email: DNH_Enforcement@cms.hhs.gov.

CMS – New COVID-19 F-tags & Updated Survey Tools

CMS has established two new F-Tags – F884: COVID-19 Reporting to CDC and F885 COVID-19 Reporting to Residents, their Representatives, and Families.

CMS has updated survey tools including COVID-19 Focused Survey for Nursing Homes, Entrance Conference Worksheet, COVID-19 Focused Survey Protocol, and Summary of the COVID-19 Focused Survey for Nursing Homes. These updated forms are posted to the Survey Resources folder in the COVID-19 Focused Survey sub-folder on the CMS Nursing Homes website.

• Action: Facilities should begin using the revised “COVID-19 Focused Survey for Nursing Homes” to perform their self-assessment.  Surveyors will begin using these revised documents immediately.

CMS – Public Posting of NHSN Data Anticipated By End of May

CMS anticipates publicly posting CDC’s NHSN data (including facility names, number of COVID-19 suspected and confirmed cases, deaths, and other data as determined appropriate) weekly on Monday’s at https://data.cms.gov/ by the end of May.

CMS – Multiple Q&A

CMS provides 22 Q&A in the last 7 pages of the memo. Question 10 addresses retrospective reporting and reads as below:

• Q: Are facilities required to report data that predates the effective date (May 8) of the interim final rule?
• A: No, there is no requirement in the rule to collect older data.

May 6th, 2020

FREE AUDIO: 2:00 – 2:30 pm  |  WEDNESDAY, MAY 6^th

Dietary/Nutrition – Back to” Normal”, Adapting what we have learned from COVID-19 and transitioning to the new normal- 

Presenter:  Carole DeBonte   |   Director of Nutrition & Wellness – Morrison Living

Call-in Number: 1-800-220-9875       Passcode: 14227658#

Carole DeBonte has over 30 years of experience in long-term care communities.  In this audio, Carol will discuss what has been learned in the dietary and nutrition areas from COVID-19.

Audio Objectives –

• A brief overview of where we are today
• Suggestions to adapt dining to incorporate social distancing and infection control. Will we have salad bars, self-serve options, beverage dispensers including coffee and water for self-service?
• Sanitizing and disinfecting dining and entertaining today and tomorrow
• Creating a new hospitality model

May 3rd, 2020

#58 AHCA/NCAL – New Reporting Requirements for Nursing Homes Effective May 1

In Update #56, we communicated about CMS release of an interim final rule with comment period which revises § 483.80, establishing explicit reporting requirements for long-term care (LTC) facilities to report information related to COVID-19 cases among facility residents and staff. These reporting requirements are applicable on the effective date of this interim final rule, which is the date of the publication at the Office of the Federal Register. CMS has informed AHCA that the new requirements for nursing homes in this rule was effective as of May 1.  CMS’s intention is that the first of the weekly reportings to CDC in the NHSN COVID-19 module are submitted by May 8. We are advocating that there be a grace period for enforcement of this rule given the lack of clarity on the notifications to residents, their representatives and families, as well as the technical complexities and quantity of information that must be submitted to CDC for NHSN COVID-19 reporting.

AHCA is developing resources to help members with these new requirements, including a template communication for notifications to residents, their representatives and families. AHCA is also working with CDC NHSN team to get resources to members on using NHSN. See article below for further developments on that front.

#58 AHCA/NCAL – More Materials Available from CDC NHSN on New COVID-19 Module for Nursing Homes

CDC NHSN has released more materials for nursing homes to prepare for this new reporting requirement, including a guide to using the COVID-19 module. Visit the CDC website to sign up for updates.

There are two upcoming webinar trainings for the new LTCF COVID-19 Module. The training webinars will be recorded and posted to the LTCF COVID-19 Module webpage with a PDF of the slide presentation.

COVID-19 Module for Long-term Care Facilities Enrollment Guidance 
Monday, May 4, 2020
2:00 – 3:30 PM Eastern Time

COVID-19 Module Overview for Long-term Care Facilities 
Tuesday May 5, 2020
3:00 – 4:30 PM Eastern Time

Learn how to join these webinars on the CDC NHSN website. If you have any questions, please email CDC at NHSN@cdc.gov and include LTCF COVID-19 in the subject line.

#58 AHCA/NCAL – PPE Burn Rate Calculator – Mobile App

The Personal Protective Equipment (PPE) Burn Rate Calculator is now available as a mobile app. Facilities can use the NIOSH PPE Tracker app to calculate their average PPE consumption rate or “burn rate.” The app estimates how many days a PPE supply will last given current inventory levels and PPE burn rate. For the excel version, please visit the CDC website.

May 1st, 2020

TOWN HALL CALL

Thank you for joining us, The Bonadio Group, for today’s Town Hall Call.

This presentation is intended for general educational and/or informational purposes only and does not replace specific, independent professional advice. This presentation is based on our current interpretations of the law. These interpretations may ultimately, after further legislative changes or regulatory guidance, be changed.

COVID Funding Presentation – Bonadio 043020

April 29th, 2020

NYSDOH – Administrator Letter for your Facility(ies)’ Obligations under Public Health Law and Regulations

This letter is intended to serve as a reminder of your facility(ies)’ obligations under Public Health Law and regulations to ensure that all residents receive the care they need. Specifically, pursuant to 10 NYCRR section 415.26, nursing homes must only accept and retain those residents for whom the facility can provide adequate care.

• 04-28-2020 – NYSDOH – Obligations under Public Health Law and Regulations 

NYSDOH – Updated Interim Guidance: Protocol for COVID-19 Testing Applicable to All Health Care Providers and Local Health Departments

• 04-28-2020 – NYSDOH – Protocol for COVID-19 Testing Applicable to All Health Care Providers

NYSDOH – Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance)).

• “At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
• • At least 7 days have passed since symptoms first appeared.”

The CDC updated its guidance to address asymptomatic workers thereafter

• 04-28-2020 – NYSDOH – Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19

NYSHFA Press Statement 3.29.20 v3 (002)

 FREE AUDIO

Reimbursement and Coordination of Care in a Challenged Environment

Zimmet Healthcare Services Group Presenters: Marc Zimmet, President  |  Sheryl Rosenfield, Director of Clinical Operations

Wednesday, April 29, 2020   |  2:00-2:30pm

Call-in Number: 1-800-220-9875.   Passcode: 14227658#

Clinicians are now faced with critical workflow and documentation decisions in this unprecedented environment, specific to increased acuity of patients, infection control protocols, and care delivery with fast-paced admissions and discharges.

This audio will help you:

• Identify the “hows” and “musts” of hospital transfer information
• Document individual patient assessments for care delivery, planning and reimbursement
• Focus on the maximum collection and coordination of information in the least challenging formats
• Highlight the collection and timing of core clinical drivers for patient care, MDS assessment and reimbursement for Medicare and Medicaid
• Discuss the Medicare waiver and NYS CMI requirements for orders, certifications, documentation of diagnoses, resident function, treatments and medications
• Help the clinical team to provide and coordinate care and capture of services

NYSHFA / NYSCAL is proud to haveZimmet Healthcare Services LLC  as a 2020 Platinum Sponsor

April 28th, 2020

NYSDOH Updated Interim Guidance: Protocol for COVID-19 Testing Applicable to All Health Care Providers and Local Health Departments

Appropriate and efficient standards for testing are an essential component of a multi-layered strategy to prevent sustained spread of COVID-19. New York State continues to increase testing capacity for COVID-19 on a daily basis to ensure resources are being efficiently and equitably distributed. This NYSDOH guidance is necessary to ensure that New York State prioritizes resources to meet the most urgent public health need.

Be Ready for a NYSDOH Focused Infection Control Survey

We are again disseminating the Infection Control COVID-19 Nursing Home Survey developed by CMS and CDC so facilities can educate themselves on the latest practices and expectations if NYSDOH enters your building to conduct an unannounced Focused Infection Control survey. The surveyors are looking at staff compliance to infection control practices. As we have been reinforcing with you since the beginning, DOCUMENT all actions related to COVID-19 and infection control in your building for staff education, requesting PPE and other needed supplies from your OEM.

Make sure your staff are providing direction and supervision, especially for new members on your staff. Additional staff observations conducted by surveyors include auditing staff actions such as hand hygiene, correct use of PPE and staff knowledge on identification of the signs and symptoms of infection. Make sure all your staff can verbalize and demonstrate the positive infection control actions going on in your building to prevent the spread of infection.

Set up an organized method (i.e. binder or computer folder) to capture your documentation on specific actions which highlight your preparedness, utilize the attached CMS Focused Infection Control checklist as your guide. Demonstrate the current implementation of the Infection Control Plan in your building, how you are monitoring practices using Line Lists and tracking data and documenting the information daily on HERDSs.

Call NYSHFA/NYSCAL with any questions.

#53 – ACHA/NCAL – Preparing for Future Surveys: Document Your Calls For Help

As noted in previous COVID-19 AHCA/NCAL updates, the association has developed brief guidance for facilities facing personal protective equipment and staffing shortages, as well as other challenges in receiving assistance. Most long term care providers do not have access to the adequate supplies or staff to provide the level of care needed to contain the virus. Documenting requests for assistance is a critical part of managing of the long term consequences of the lack of supplies and testing – and preparing for future surveys.

Unfortunately, also due to this crisis, many long term care providers are unable to fulfill requests for help made to regular contacts (e.g., suppliers, morgues, staffing agencies, etc.) and through traditional communication channels. Long term care providers need to regularly call for help and need to document these calls were made. Continue to reach out to these entities:

• Contact the local AND state health departments
• Contact the state survey agency
• Consider contacting local government officials such as the mayor, state representative or state senator

Be sure to check out the AHCA/NCAL guidance, which also has information on how to properly document calls for help and the importance of requesting a facility level waiver.

#53 – ACHA/NCAL – FEMA Shipping SNFs a Supply of PPE in Early May and Again in June

The White House Coronavirus Task Force announced yesterday that FEMA will be shipping to every nursing home in the United States a supply of PPE (surgical masks, gowns, face shields and gloves) in early May and again in early June. As we learn more about the arrival dates and amounts, we will let you know.

April 27th, 2020

CMS COVID-19 Stakeholder Engagement Calls – Week of 4/27/20

CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts.

Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. These calls are not intended for the press.

Calls recordings and transcripts are posted on the CMS podcast page at:https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts

April 26th, 2020

#52 – AHCA/NCAL Grant & Loan Management Resource Guide

To aid members with managing the array of federal grants and loans, AHCA/NCAL has developed a basic primer  (login required) for organizing oversight and day-to-day management of these emergency resources. The guidance includes federal cost reporting guidelines as well as recommended financial management approaches for members. This document is the Association’s first version; updates will be developed as the federal government and states release new or updated guidance.

To download the Resource Guide, log into the AHCA/NCAL website and go here, or the Finance & Reimbursement section of our COVID-19 webpage.

#52 – AHCA/NCAL COVID-19 Related Loss and Cost Calculator

Also, available exclusively to AHCA/NCAL members is a COVID-Related Loss and Cost Calculator  (login required). The purpose of this excel workbook is to offer a basic tool for members to assess allowable costs already reimbursed by pre-COVID payers, such as Medicare and Medicaid, and compare such reimbursement to shortfalls where grants and loans fill funding gaps. This tool will be particularly useful with reporting on and documenting use of the CARES Act Provider Relief Fund grants.

To download the calculator (an Excel workbook), log into the AHCA/NCAL website and go here, or the Finance & Reimbursement section of our COVID-19 webpage.

#52 – AHCA/NCAL Updated – Accelerated and Advance Payments FAQs

The AHCA Medicare Accelerated and Advance Payment FAQs have been updated to reflect the April 26 CMS announcement that it is reevaluating the amounts that will be paid under its Accelerated Payment Program to Part A facility-based providers (including SNF) and suspending its Advance Payment Program to Part B suppliers effective immediately.

Specifically impacting SNFs, beginning on April 26, 2020 CMS will be reevaluating all pending and new applications for Accelerated Payments submitted by SNFs and other facility-based providers in light of the $175 billion recently appropriated for health care provider relief payments. Significant additional funding will continue to be available to healthcare providers through these other programs.

April 25th, 2020

No. 202.23: Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency

• New York State Continuing Temporary Suspension and Modification Laws Relating Disaster Emergency

April 23rd, 2020

Additional $75 Billion for Provider Relief in Stimulus Funds Passed Today

Today, the House approved and the President is expected to quickly sign the Paycheck Protection Program and Health Care Enhancement Act, a bill that was passed by the Senate this week. The bill provides:

• $75 billion for health care providers to support the need for COVID-19 related expenses and lost revenue. This funding is in addition to the initial $100 billion provided in the Provider Relief Fund as part of the CARES Act.
• $25 billion for COVID-19 testing
• $321 billion increase in the Small Business Administration’s Payment Protection Program (PPP) loan to allow for more small businesses to apply to receive aid.

All of the provisions above are in addition to the provisions that are in the CARES Act, that was signed into law by the President last month.

THERE IS NO NYSHFA | NYSCAL TOWN HALL CONFERENCE CALL

Check your inbox for details of next weeks Town Hall Call!

NYSDOH: Healthcare Provider COVID-19 Weekly Call 4.23.20

Please join the NYS Department of Health Thursday, April 23rd at 1:00 PM – 2:00 PM for a COVID-19 update for healthcare providers.

To accommodate the large number of participants, our webinar will be streaming via YouTube Live:

https://coronavirus.health.ny.gov/weekly-healthcare-provider-update

For audio-only, please dial in: 844-512-2950

For questions: Please send an e-mail to bcdc@health.ny.gov.

#47 AHCA/NCAL – Additional Distribution of Provider Relief Funds

Two weeks ago, we learned that skilled nursing would be included as part of the stimulus bill’s (aka the CARES Act) $100 billion Provider Relief Fund, whenHHS distributed the first $30 billion from the fund and all skilled nursing facilities received 6.2% of their 2019 Part A and Part B Medicare payments. Today, HHS announced an additional $40 billion in distributions, with checks going out as early as this Friday. Here is what we know so far.

1. SNFs are clearly part of a tranche of funds that HHS is using to pay providers based on their total revenue. It will distribute $20 billion of the $40 billion based on a percentage of providers total revenue, but will make some adjustment for Medicare revenue, that was recognized in the prior payment. We do not know the exact formula yet, but providers who have a high level of Medicaid and/or Medicare Advantage, will do proportionally better than those who do not.
2. HHS is also distributing $10 billion to those in COVID-19 hotspots. This may be for hospitals only. We are verifying that and if we are not part of these funds, we will seek reimbursement for SNF and AL COVID hotspots in future funding.
3. HHS is also distributing $10 billion to rural hospitals.

The additional news is that tomorrow Congress will likely add $75 billion to this fund. That will replenish the fund to slightly over $100 billion. We will work to continue to receive the funding you deserve as you fight the daily battles in your buildings. As we learn more about the formula utilized to distribute the $20 billion, we will let you know.

#47 AHCA/NCAL – COVID-19 Emergency Declaration Blanket Waivers for ICFs/IID

Today, CMS released additional blanket waivers on staffing and training modifications in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID). More waivers are yet to come down the way for ICF/IID providers. Today’s release includes:

• Staffing Flexibilities
• Suspension of Community Outings
• Suspend Mandatory Training Requirements
• Modification of Adult Training Programs and Active Treatment

Additional details can be found in the full overview of the waivers.

#47 AHCA/NCAL – Update on Pending Requirement for National Healthcare Safety Network (NHSN) Reporting

As announced in CMS memo earlier this week, CMS will be issuing a new requirement for nursing homes to report to CDC’s National Healthcare Safety Network which is the nation’s most widely used healthcare-associated infection tracking system. AHCA along with other stakeholders met with staff from CDC NHSN to seek more information about accessing NHSN and the reporting requirements. Key takeaways providers should be aware of are:

1. There will be an option for an expedited registration and credentialing process for new users of NHSN. It is estimated to take one hour via email communication to complete this process.
2. Reporting to NHSN will likely be required weekly.
3. There will be a probable grace period from enforcement to allow for rollout of this new requirement. CMS will determine the length of time of that grace period which is not known at this point.

The goal of reporting to NHSN is to:

• Augment case reporting to understand facility specific impact
• Identify resource needs and prioritize public health action

NHSN will be providing training and support such as office hours and a user support desk in the coming weeks. We will share more information as it becomes available from CDC NHSN and when CMS issues the rule for these requirements.

#47 AHCA/NCAL – ASPR Webinar – Protecting Our Frontline Health Facilities from Evolving Security Threats during COVID-19

On Friday, April 24, at 1:00 pm EDT, the Department of Health and Human Services (HHS) is partnering with the Department of Homeland Security (DHS) and InfraGardNCR on a webinar series to inform the private sector, state and local government first responders, and public healthcare professionals of potential increased threats to HPH facilities.

Register for the webinar here. You must register in advance to attend the webinar. After you register, you’ll receive connection details from GoToWebinar. Send any questions to infragardncr@fbi.gov.

April 22nd, 2020

CMS Request for Best Practices in Response to COVID-19

NYSHFA | NYSCAL has received a request from CMS asking us to collate state-specific information on actions undertaken and best practices identified related to nursing homes in response to the COVID-19 pandemic. These can be policy or payment driven actions or best practices created in response to the pandemic for nursing homes. Any providers interested in sharing best practices, as well as be potentially showcased on the CMS calls, please reach out to:

JACKIE PAPPALARDI, RN, BSN
Executive Director, Foundation for Quality Care

Phone:518-462-4800, Ext. 16
E-mail:jpappalardi@nyshfa-nyscal.org

OR …

LISA M. VOLK, RN, B.P.S LNHA
Director, Clinical & Quality Services

Phone:518-462-4800, Ext. 15
E-mail:lvolk@nyshfa.org

CMS – Trump Administration Launches New Toolkit to Help States Navigate COVID-19 Health Workforce Challenges

At President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) and the Assistant Secretary of Preparedness and Response (ASPR) released a new toolkit to help state and local healthcare decision-makers maximize workforce flexibilities when confronting 2019 Novel Coronavirus (COVID-19) in their communities. This toolkit includes a full suite of available resources to maximize responsiveness based on state and local needs, building on President Trump’s commitment to a COVID-19 response that is locally executed, state-managed, and federally supported. This work was developed by the Healthcare Resilience Task Force as part of the unified government’s response to COVID-19.

The COVID-19 Healthcare Workforce Toolkit also provides up-to-date best practices so that state and local healthcare decision makers have a go-to resource to know what’s been implemented in the field and to find out how it’s working. The toolkit is available online and includes an assistance center, information exchange of case studies and additional peer-to-peer communications that can be used to help local communities determine the best way to battle the COVID-19 based on their unique needs.

To view the COVID-19 Healthcare Workforce Toolkit, visit:https://asprtracie.hhs.gov/Workforce-Virtual-Toolkit

NYSDOH – Extension of the 2020 Compliance Period for Facility Evacuation Planning

The New York State Department of Health (Department), Office of Primary Care and Health Systems Management (OPCHSM) recognizes the tremendous amount of work that providers currently are facing in order to safeguard their staff, patients, residents, and the public health due to the ongoing outbreak of novel coronavirus (COVID-19).  The Department also recognizes that this additional workload will continue for at least the next several weeks.

Given these extraordinary circumstances, the Department has decided to extend the compliance period for providers to complete the work that was outlined in the Dear CEO and Administrator Letter (DAL) of December 20, 2019, and that originally was due to be completed by March 31, 2020 (original DAL attached).  This work includes provider updates for their facility, of the HERDS Critical Asset Survey and the Facility Evacuation Planning Application (FEPA) on the Department’s Health Commerce System (HCS).  The due date for completion of this work is now May 31, 2020. 

04-22-2020 – NYSDOH – Extension of 2020 Compliance Period

AHCA/NCAL – Additional Provider Relief Funds Distributed

This week, HHS will begin distribution of the remaining $20 billion of the Provider Relief Fund allocated for general distribution to providers impacted by COVID-19.

HHS will begin distribution of the remaining $20 billion so that the whole $50 billion general distribution is allocated proportional to Medicare providers’ share of 2018 net patient revenue less Medicare fee-for-service which was included in earlier distributions. On April 24, a portion of providers will automatically be sent an advance payment based off the revenue data they submit in CMS cost reports. Providers without adequate cost report data on file will need to submit their revenue information to a portal opening this week on the Provider Relief Fund website for additional general distribution funds. Providers who receive their money automatically will still need to submit their revenue information so that it can be verified. Payments will go out weekly, on a rolling basis, as information is validated, with the first wave being delivered starting on April 24, 2020.

A future distribution will focus on Medicaid only providers who do not have Medicare cost reports.

As we learn additional detail about the distribution formula, AHCA/NCAL will provide more information.

AHCA/NCAL – COVID-19 Emergency Declaration Blanket Waivers for ICFs/IID

Today, CMS released additional blanket waivers on staffing and training modifications in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID). More waivers are yet to come down the way for ICF/IID providers. Today’s release includes:

• Staffing Flexibilities
• Suspension of Community Outings
• Suspend Mandatory Training Requirements
• Modification of Adult Training Programs and Active Treatment

Additional details can be found in the full overview of the waivers.

AHCA/NCAL – Update on Pending Requirement for National Healthcare Safety Network (NHSN) Reporting

As announced in CMS memo earlier this week, CMS will be issuing a new requirement for nursing homes to report to CDC’s National Healthcare Safety Network which is the nation’s most widely used healthcare-associated infection tracking system. AHCA along with other stakeholders met with staff from CDC NHSN to seek more information about accessing NHSN and the reporting requirements. Key takeaways providers should be aware of are:

1. There will be an option for an expedited registration and credentialing process for new users of NHSN. It is estimated to take one hour via email communication to complete this process.
2. Reporting to NHSN will likely be required weekly.
3. There will be a probable grace period from enforcement to allow for rollout of this new requirement. CMS will determine the length of time of that grace period which is not known at this point.

The goal of reporting to NHSN is to:

• Augment case reporting to understand facility specific impact
• Identify resource needs and prioritize public health action

NHSN will be providing training and support such as office hours and a user support desk in the coming weeks. We will share more information as it becomes available from CDC NHSN and when CMS issues the rule for these requirements.

AHCA/NCAL – ASPR Webinar – Protecting Our Frontline Health Facilities from Evolving Security Threats during COVID-19

On Friday, April 24, at 1:00 pm EDT, the Department of Health and Human Services (HHS) is partnering with the Department of Homeland Security (DHS) and InfraGardNCR on a webinar series to inform the private sector, state and local government first responders, and public healthcare professionals of potential increased threats to HPH facilities.

Register for the webinar here. You must register in advance to attend the webinar. After you register, you’ll receive connection details from GoToWebinar. Send any questions to infragardncr@fbi.gov.

April 21st, 2020

CMS SUMMARY

CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19

As the United States continues to face the unprecedented public health emergency from the COVID-19 pandemic, the tide is turning and some areas throughout the country are seeing a decline in cases. As states and localities begin to stabilize, CMS is issuing guidance on providing essential non-COVID-19 care to patients without symptoms of COVID-19 in regions with low and stable incidence of COVID-19. This is part of Phase 1 in the Trump Administration’s Guidelines for Opening Up America Again. The recommendations update earlier guidance provided by CMS on limiting non-essential surgeries and medical procedures.

Press Release

Recommendations

Trump Administration Announces New Nursing Homes COVID-19 Transparency Effort

CMS announced new regulatory requirements that will require nursing homes to inform residents, their families, and their representatives of COVID-19 cases in their facilities. In addition, as part of President Trump’s Opening Up America, CMS will now require nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC). This information must be reported in accordance with existing privacy regulations and statute. This measure augments longstanding requirements for reporting infectious disease to State and local health departments. CMS will also require nursing homes to fully cooperate with CDC surveillance efforts around COVID-19 spread.

Press Release

Guidance Memo

Trump Administration Champions Reporting of COVID-19 Clinical Trial Data through Quality Payment Program, Announces New Clinical Trials Improvement Activity

CMS is encouraging clinicians who participate in the Quality Payment Program (QPP), such as physicians, physician assistants, nurse practitioners, and others, to contribute to scientific research and evidence to fight the COVID-19 pandemic. Clinicians may now earn credit in the Merit-based Incentive Payment System (MIPS), a performance-based track of QPP that incentivizes quality and value, for participation in a clinical trial and reporting clinical information by attesting to the new COVID-19 Clinical Trials improvement activity. This action will provide vital data to help drive improvement in patient care and develop innovative best practices to manage the spread of COVID-19 within communities.

Press Release

RHC & FQHCs: Telehealth and Virtual Communications Flexibilities During COVID-19 Public Health Emergency

To support Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and their patients, Congress and CMS made changes to requirements and payments during the COVID-19 Public Health Emergency, including:

• New payment for telehealth services, including how to bill Medicare
• Expansion of virtual communication services
• Revision of home health agency shortage requirement for visiting nursing services
• Consent for care management and virtual communication services
• Accelerated/advance payments

MLN Matters SE20016

CMS Amends Certain Activities Related to the Health Insurance Exchange Quality Rating System, QHP Enrollee Experience Survey, and Quality Improvement Strategy

CMS is easing burden on Qualified Health Plans (QHPs) during the Public Health Emergency. CMS directed plans that are eligible to report for the Quality Rating System and the Quality Improvement Strategy programs to discontinue collecting clinical quality measure data. Eligible QHPs can discontinue reporting in June 2020 for display on Exchange websites for the 2021 Open Enrollment period. CMS will continue to accept QHP Enrollee survey data submissions for this year, given that the survey administration is already underway.

Guidance

CMS Approves Additional State Medicaid Waivers and Amendments to Give States Flexibility to Address Coronavirus Pandemic

CMS has approved 53 COVID-related emergency waivers, 39 state amendments, 16 COVID-related Medicaid Disaster Amendments and one CHIP COVID-related Disaster Amendment in record time. States are using a toolkit CMS developed to expedite the application and approval of Medicaid state waivers and State Plan Amendments.

CMS recently approved an additional COVID-related emergency Medicaid waiver for Wisconsin, delivering urgent regulatory relief to ensure the state can quickly and effectively care for its most vulnerable citizens. CMS also recently approved COVID-19 related Medicaid Disaster Amendments that bring relief to Guam, Louisiana, Maryland, and Minnesota. These approvals help to ensure that states have the tools they need to combat COVID-19 through a wide variety of state plan flexibilities. CMS continues to authorize amendments to ensure emergency flexibilities in programs that care for the elderly and people with disabilities, including most recently for the District of Columbia, Florida, Mississippi, Nebraska, Utah, and Virginia. These approved flexibilities support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

Section 1135 Waivers

1915(c) Waiver Appendix K Amendments

Medicaid State Plan Amendments

CHIP State Plan Amendments

AHCA Releases Communication Strategies for Keeping Families Up to Date On Cases of COVID-19

In response to the CMS April 19 2020  Memorandum stating new regulations would be forthcoming regarding requiring nursing homes to notify its residents and their representatives of the specific COVID-19 related conditions inside the facility within specified timeframes, AHCA has compiled effective communication strategies that could be used by nursing homes.

As background to the list of strategies contained in this message, AHCA reiterates the importance of effective communication is always important but is especially critical in this COVID-19 environment with heightened emotions, fear of the unknown, and restrictions on family member in-person visitation. Family members want to know that their loved one is safe, that providers are doing everything possible to protect their loved ones, and to feel a sense of connectedness especially because they can’t be with their loved ones.

AHCA/NCAL has developed some potential tactics and strategies to keep family members and loved ones up to date.

April 20th, 2020

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

• 04-20-2020 – NYSDOH – Guidance for Resident and Family Communication

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

• 04-20-2020 – NYSDOH – Advisory – Discontinuation of Isolation for Patients with COVID-19

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.

• 04-20-2020 – NYSDOH – DAL – Guidance for Nursing Homes on Managing Resident Deaths

NYSDOH – New York State Medicaid Program Launches Online Medicaid Provider Enrollment During COVID-19 Public Health Emergency

Pursuant to section 1135(b)(1)(B) of the Social Security Act, the Centers for Medicare and Medicaid Services (CMS) has allowed states to temporarily waive and/or suspend some of the requirements for providers who wish to temporarily enroll in fee-for-service (FFS) Medicaid for the purpose of assisting with the COVID-19 public health emergency.

• 04-20-2020 – NYSDOH – COVID-19 Provider Enrollment Special Edition Medicaid Update

Trump Administration Announces New Nursing Homes COVID-19 Transparency Effort Agencies partner with nursing homes to keep nursing home residents safe

CMS Issues Recommendations to Re-Open Health Care Systems in Areas with Low Incidence of COVID-19

April 17th, 2020

Stephen Hanse, President & CEO of NYSHFA | NYSCAL speak with WCNY Connected and discuss the way these facilities are working to protect residents

NYSDOH COVID-19 Control Measures for Adult Care Facilities

• • 04-17-2020 – NYSDOH – COVID19 Adult Care Facilities Control Measures

NYSDOH Adult Care Facility COVID-19 Preparedness Checklist

Why are we sharing this tool? The New York State Department of Health (“Department”) has identified Adult Care Facilities (ACFs) to be vulnerable places for spread of COVID-19. It is imperative that ACFs take steps to prevent introduction, recognize staff and residents with possible COVID-19, and minimize transmission within the facility.

Below is the NYSDOH COVID-19 Infection Prevention and Control (IPC) preparedness checklist. This tool is intended as a self-assessment and provides ACFs with all the IPC elements that need to be in place both before and after recognition of a confirmed, suspect, or possible COVID-19 case in the facility.

The elements of the checklist are adapted from guidance issued by the Centers for Disease Control and Prevention (“CDC”) and Department-issued health advisories. This checklist may be updated as the situation evolves.

• • • 04-17-2020 – NYSDOH_COVID19_ACF-IPC Self Assessment Tool

CMS Focused Survey for Nursing Homes

CMS issued a QSO memo announcing the release of a focused survey that can be used to identify and correct deficient practices in order to control and prevent the transmission of the virus.

There are four documents associated with this training. The four documents include the Summary table, the survey protocol, the entrance conference form and the survey tool.

• • • 04-17-2020 – CMS – Surveyor Training COVID-19 Focused Survey for Nursing Homes

Hilton’s Rooms Donation Program to Frontline Medical Workers

Hilton and American Express have partnered to donate up to one million free hotel nights to our association and other frontline medical professionals, so you can have a safe and welcoming place to stay as you support those impacted by COVID-19.

Bookings can be made for up to 7 consecutive nights at a time and are currently open through May 9th. The program will run through May 31st with rooms being added through the end of May on a rolling basis, subject to availability.

To search available hotels and book, log in on AHCA/NCAL’s website, and go to www.ahcancal.org/Hilton-Partnership to find a link to the program. Hilton has required that participating associations limit the offer to members to help ensure that the offer gets to who it was intended to reach – frontline health care workers treating COVID-19.

April 15th, 2020

NYSHFA/NYSCAL Weekly Town Hall Call – April 16 at 11am

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 next Town Hall Call will be on Thursday, April 16, 2020 from 11:00 am – 11:30 am and will continue every Thursday at 11:00 am until further notice. Agendas listing topics will be sent at the beginning of each week. For future topics most important to your needs, please send us the top 2-3 topics and/or concerns you want information on at this time.  Please send your ideas to Jackie Pappalardi (jpappalardi@NYSHFA-NYSCAL.org).

NYSDOH HCP COVID-19 Update Webinar Thursday, April 16 (1pm-2pm)

DOH will hold their weekly COVID-19 Update on Thursday, April 16 at 1-2 pm. See below for full information.

Please join the NYS Department of Health Thursday, April 16^th at 1-2 PM for a 

COVID-19 update for healthcare providers. To accommodate the large number of participants, our webinar will be streaming via YouTube Live: https://coronavirus.health.ny.gov/weekly-healthcare-provider-update

For audio only, please dial in: 844-512-2950

NYSDOH Commissioner of Health Conducts COVID-19 Conference Call with SNF Providers

Dr. Howard Zucker, NYS Commissioner of Health, held a special conference call today (04-15-2020) with all nursing home administrators and directors of nursing. Dr Zucker explained the purpose of the call was to collect critical data on COVID-19 status in nursing homes to identify trends in New York.

The tentative SNF data collection time period was stated starting March 1, 2020 – April 16, 2020 (please note specifics on the survey). Topics will include:

• • • Current SNF daily census
    • # of residents who have tested COVID-19 positive
    • # suspected residents with COVID-19
    • # of those residents who have recovered
    • Average # of deaths/day normally in the SNF over a year’s time
    • # of Deaths from Positive and Suspected COVID-19
    • # of COVID Positive or Suspected Positive residents transferred to the hospital

In addition, Dr. Zucker answered a variety of questions from SNFs including:

• • • Testing is now a priority for SNF for residents and staff. The tests are becoming more available with easier methods of collection and quicker turnaround times.
    • Updated testing guidance will be forth coming on testing soon.
    • Quarantine Procedures: The 14-day quarantine and isolation protocols were reviewed.
    • Privacy of data: Providers discussed the ability to have their data be used in aggregate vs specific SNF. This issue will be deferred to Division of Legal Affairs.
    • Hospital transfers: many COVID-19 positive patients were admitted from the hospital should be counted; and the
    • Media: the need for assistance with the negative media focusing on SNF and their staff.

NYSHFA is encouraging all skilled nursing facilities to start compiling this data now to complete the survey in a timely manner. If we can assist you in any way, please contact us at NYSHFA.

IPRO Request for NHs to Join the Nursing Home Quality Care Collaborative

IPRO has been reaching out to nursing homes across the state with requests to join the CMS initiative: Nursing Home Quality Care Collaborative (NHQCC). By joining the NHQCC your organization will receive technical support and assistance, at no cost, to help you transform the quality of care provided by your nursing home and improve resident outcomes.

The opportunity to partake in the collaborative is time sensitive ending April 2020 – your quick response is critical to ensure your nursing homes participation into this valuable program.

Sign up now to participate

April 14th, 2020

𝗘𝗻𝘃𝗶𝗿𝗼𝗻𝗺𝗲𝗻𝘁𝗮𝗹 𝗦𝗲𝗿𝘃𝗶𝗰𝗲𝘀 𝗕𝗲𝘀𝘁 𝗣𝗿𝗮𝗰𝘁𝗶𝗰𝗲𝘀 𝗮𝗻𝗱 𝗛𝗲𝗹𝗽𝗳𝘂𝗹 𝗧𝗶𝗽𝘀
🔊April 15, 2020  |  2:00pm – 2:30pm

In today’s pandemic, Environmental Services play a huge roll in prevention. Please join us, 𝗪𝗲𝗱𝗻𝗲𝘀𝗱𝗮𝘆, 𝗔𝗽𝗿𝗶𝗹 𝟭𝟱𝘁𝗵 @ 𝟮:𝟬𝟬𝗽𝗺, as Jesse Cash, the Regional Director of Operations at Morrison Living, uses his 15+ years experience of Environmental & Plant Operations to discuss the importance of implementing Environmental Services in your programs during this pandemic.

His expertise ensures a consistent, high-quality outcome from teams he supports in senior living. With a focus metrics based on housekeeping, Jesse’s specialties lie in program implementation, policy & procedure best practices and cutting edge technology.

𝗛𝗔𝗩𝗘 𝗔 𝗦𝗣𝗘𝗖𝗜𝗙𝗜𝗖 𝗤𝗨𝗘𝗦𝗧𝗜𝗢𝗡 𝗬𝗢𝗨’𝗗 𝗟𝗜𝗞𝗘 𝗔𝗡𝗦𝗪𝗘𝗥𝗘𝗗?
👉Let us help! Please email Melony @ mspock@nyshfa.org so we may address it in the audio. 🔊

AHCA/NCAL Recommendations for When a Resident Wants to Leave the Building

AHCA/NCAL has developed recommendations to help you address when a resident wants to leave the building to go into the surround community and then return. This could introduce COVID-19 into the building and endanger others. Our recommendations include communicating with the resident and family, requiring isolation, and contacting the ombudsman and the local health department.

AHCA/NCAL – CARES Act Provider Relief Funds FAQs

On Friday, April 10, the U.S. Department of Health and Human Services (DHHS) released the first round of the $100 billion in relief funds to hospitals and other health care providers on the front lines of the coronavirus response. This funding will be used to support health care-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get testing and treatment for COVID-19.

AHCA/NCAL has developed some FAQs specific to long term and post-acute care providers.

AHCA/NCAL – Medicaid FAQs

Yesterday evening, CMS released guidance to states on Medicaid-related COVID-19 issues. Although the guidance covers a range of topics, including implementation of coverage for COVID-related services for the uninsured and benefits and cost sharing for COVID-19-related testing and diagnostic services, below we have highlighted items important to long term care providers:

Treatment of Relief Payments in CARES Act

CMS clarifies that the relief payments eligible people receive from the CARES Act may not be counted as income when making Medicaid and CHIP eligibility determinations. In addition, these payments may not be counted as resources for 12 months (Question 54).

Eligibility Considerations for States to Receive Enhanced Federal Matching Rates

To continue to receive the temporary FMAP increase, the state must not cut eligibility for benefits during the public health emergency, even if that person no longer meets the existing eligibility criteria. Several questions in the FAQ document address targeted questions states have raised related to people using long term services and supports, or who become eligible for Medicare as well as Medicaid. These include:

• • • When a Person no Longer Meets Level of Care (LOC) or Other Requirements of a 1915(c) Waivers: If a person is participating in a 1915(c) home and community-based services (HCBS) waiver and they are determined to no longer meet the LOC requirements (or other requirements) for the waiver, the state should maintain an individual’s participation in a 1915(c) waiver for which the individual is enrolled during the emergency period, even if the individual is determined to no longer meet the LOC or other requirements for waiver participation (Question 25).
    • When a Person’s Medicaid Eligibility Is Connected to Need for 1915(c) Waiver Services and They No Longer Meet LOC Requirements: If a person’s Medicaid eligibility is connected to their need for and receipt of 1915(c) waiver services, and they are determined to no longer meet the LOC requirements, to continue to receive the enhanced federal matching rate, the state must maintain the individual in this eligibility group and continue to provide coverage for 1915(c) services, unless they are now eligible for a different eligibility group that provides the same amount, duration, and scope of benefits (Question 26).
    • Medicaid beneficiaries who become eligible for Medicare: If a person enrolled in Medicaid turns 65 and becomes eligible for Medicare during this time, CMS clarifies steps the state would have to take to ensure that their services are not reduced so that the state can continue to receive the 6.2% federal matching bump (Question27).
    • Changes in SSI eligibility when this is the basis for Medicaid eligibility: If a person who is eligible for Medicaid based on their receipt of SSI benefits were to become ineligible for SSI during the public health emergency, they may not be terminated from Medicaid before the end of the month when the public health emergency ends. If the person is eligible for a different Medicaid eligible group that offers at least the same benefits available to SSI beneficiaries, the state is able to move them to that new group (Question 33).
    • Moving between Medicare Savings Program (MSP) groups: During the public health emergency, states must maintain a person’s eligibility for at least the same amount, duration, and scope of benefits as are covered for the group in which the individual is enrolled. This includes paying for Medicare Part A and Part B premiums through MSPs and other Medicaid categories. This means that a person could not be moved to a different MSP group that offers less assistance with Medicare premiums and cost sharing during the emergency (Question 34).

1915(k) Clarification and EFMAP

CMS addressed an incorrect statement in a previous FAQ document, clarifying that Community First Choice 1915(k) service expenditures are in fact eligible for the enhanced federal matching rate of 6.2 percent under this public health emergency (Question 36).

Disposable Face Shields Available from MIT

The Massachusetts Institute of Technology (MIT) has designed and licensed a manufacturer to produce disposable face shields in high volume. These face shields do not replace the need for face masks such as N95s but do offer splash protection and can extend the useful life of N95 respirators and surgical masks.

Long term care facilities facing shortages of face masks and other PPE should continue efforts to obtain N95s and other PPE, even if they order the MIT face shields. The face shields cost $348.75 for a box of 125 ($2.79 each). Learn more and access their order form at mitshield.com.

Marriott Community Caregivers Rate

Marriott is offering a “Community Caregivers Rate” to expedite the booking process for healthcare and relief professionals and support staff. This rate will be available from March 26, 2020 through June 30, 2020 at participating hotels.

CMS is providing supplemental information for transferring or discharging residents between facilities for the purpose of cohorting residents based on COVID-19 status (i.e., positive, negative, unknown/under observation).

• • • 04-13-2020 – CMS – Tranferring or Discharging  Guidance QSO-20-25-NH

April 13th, 2020

NYSDOH: COVID-19 Drug Topics

The Department of Health today issued COVID-19 Drug Topics, which provides prescribers with an evidence-based, non-commercial source of the latest objective information about pharmaceuticals. The information is provided through our Prescriber Education Program (PEP), which is a partnership between the Department of Health and the State University of New York (SUNY) Medical and Pharmacy institutions.

Information regarding Colchicine, Hydroxychloroquine and Ibuprofen is now available on the COVID-19 Guidance for Medicaid Providers webpage.

Medicaid Redesign Team Updates
Office of Health Insurance Programs
New York State Department of Health
Albany, NY 12237
mrtupdates@health.ny.gov

CMS Issues FY 2021 Proposed Payment Rule

CMS has issued its SNF Prospective Payment System (PPS) Proposed Rule for fiscal year 2021.

The proposed rule incudes a net market basket increase of 2.3%, which approximates $784M nationwide. The increases, upon final approval, would be effective 10/1/20.

Below is the AHCA announcement which contains a detailed summary of the proposed rule.

The Centers for Medicare & Medicaid Services (CMS) today issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2021 update.

The proposed rule includes a net market basket increase of 2.3 percent. CMS estimates that the net market basket update would increase Medicare SNF payments by approximately $784 million in FY 2021.

In regard to PDPM monitoring, CMS indicates the Agency will continue to monitor the impact of PDPM implementation on patient outcomes and program outlays.  CMS notes that it would be premature to release any information related to these issues based on the amount of data currently available.”

Finally, of note, as part of updating CBSAs, CMS is capping decreased in wage indices at 5 percent to prevent precipitous drops.

The team at AHCA team has developed a summary of the payment updates, the SNF value-based purchasing program, and the IMPACT Act quality reporting additions.

AHCA/NCAL: COVID-19 Testing and Vendors

AHCA/ NCAL held a meeting today to discuss that COVID-19 testing continues to be a significant point of concern for LTC providers. AHCA/NCAL has put together a couple of resources around testing that they want to make sure you are aware of:

• • • Background on Testing in LTC: This document outlines the key issues in obtaining testing and provides a full explanation of the difference between a PCR and an antibody test.
    • Vendors that can Test in LTC: AHCA/NCAL has been seeking vendors that can provide rapid PCR testing for LTC organizations and has created a list here. They are in the process of vetting more vendors, so this list will continue to be updated as more become available.

For members seeking testing from new lab vendors, AHCA/NCAL would recommend the following:

• • 1. Use lab that will bill Medicare directly for Part B
    2. Test residents before skilling

If you have any additional questions, please contact them at COVID19@ahca.org.

NYSHFA-NYSCAL received the following advisory from the Department of Homeland Security and Emergency Services:

On March 20, 2020, the State of New York received a major disaster declaration (DR-4480) to provide emergency protective measures (Category B) under the Public Assistance (PA) program through the disaster declaration. On April 9, 2020, FEMA approved New York’s statewide plan for non-congregate sheltering. This approval allows governmental entities and private non-profits (PNPs) to utilize hotel and motel rooms as non-congregate sheltering for certain defined populations. The costs associated with non-congregate sheltering conforming to New York’s approved plan would be eligible for partial reimbursement under FEMA’s Public Assistance program. A slide deck outlining the State’s non-congregate sheltering plan and FEMA’s requirements for applicants to implement that plan is attached.

New York’s statewide NCS plan identifies 3 target populations for non-congregate sheltering:

• COVID-19 positive individuals requiring isolation but not hospitalization and who do not have an appropriate home setting, or have a medically vulnerable individual in the home setting where they would otherwise be isolated;
• Healthcare providers and emergency responders interacting with presumptive or confirmed positive COVID-19 patients in an occupational setting, to include testing sites; and
• Individuals that are or were supported by a congregate care shelter facility, to include homeless persons, domestic violence survivors, and elder abuse survivors.

Please note that New York City received approval for a citywide non-congregate sheltering plan on March 30, 2020. The statewide non-congregate sheltering plan differs slightly from the citywide plan in terms of populations identified. FEMA will allow entities in NYC to utilize the statewide plan if they wish to include those additional populations approved in the State plan.

The Department of Homeland Security and Emergency Services( DHSES) will be including this information in our upcoming applicant’s briefings and will post it to our website at: http://www.dhses.ny.gov/recovery/public/active-declarations.cfm under DR-4480. Note that DHSES continues to work with FEMA on implementation guidance under this program and additional information will be shared as it becomes known.

April 10th, 2020

NYSHFA | NYSCAL COVID-19 Press Release

• 04-10-2020 – NYSHFA | NYSCAL – Press Release

AHCA/NCAL – Best Practices for Social MediA at Your Skilled Nursing Center or Assisted Living Community

• AHCA / NCAL – Social Media Best Practices

NYSDOH: COVID-19 LTCF-IPC Self-Assessment Tool

The New York State Department of Health (NYSDOH) has identified long term care facilities (LTCFs) to be one of the most vulnerable places for spread of COVID-19. Given the burden of COVID-19 cases in NY, we have noted many introductions of COVID-19 into LTCFs, widespread transmission within some facilities once introduced, and high mortality rates among residents. It is imperative that LTCFs take steps to prevent introduction, recognize staff and residents with possible COVID-19, and minimize transmission within the facility, while keeping staff safe from further illness.

Attached is the NYSDOH COVID-19 Infection Prevention and Control (IPC) preparedness checklist. This tool is meant to be a self-assessment and provides LTCFs with all the IPC elements that need to be in place both before and after recognition of a confirmed, suspect, or possible COVID-19 case in the facility.

• 04-10-2020 – NYSDOH_COVID19_LTCF-IPC Self-Assessment Tool

OCME Procedure for Claiming Decedents at Nursing Homes

• Claim City Burial Request Checklist Nursing Homes
• ME-Clinical-Summary-Worksheet-3.0

The New York City Office of Chief Medical Examiner (OCME) has shared their guidance with NYSHFA in order to communicate quickly to our nursing home providers to maintain an accurate and timely process for the safe removal of decedents from nursing homes located in NYC.  OCME is stressing the importance of the responsibility of the City mortuary to care for all remains in custody with dignity and respect.

The nursing home process at the time of the resident’s death to notify the family/next of kin for their choice of funeral director for removal of the decedent remains in place. If there is no next of kin, thet Public Administrator must be notified and documented. If the Funeral Director is unable to pick up the decedent (within 24-48 hours), the nursing home may choose to refer to the OCME for assistance. The nursing home can inform the OCME to hold the decedent until the funeral director can take ownership.  OCME will provide temporary storage of a decedent for up to 14 days. If a decedent has not been claimed within 14 days, the decedent will be transferred for temporary interment at City Cemetery.

A request to disinter a decedent for private final disposition can be submitted directly by a funeral director to the NYC Department of Health and Mental Hygiene. There will be no charge to the claimant for disinterment. A decedent may alternatively remain at City Cemetery for final disposition; no additional notification to OCME is required

To accommodate the many New Yorkers who have been impacted by the COVID-19 pandemic, the New York City Office of Chief Medical Examiner (OCME) will provide temporary storage of a decedent for up to 14 days.  OCME has a team working 24/7 to monitor requests. OCME is reviewing the documentation for completeness prior to dispatching a recovery team. OCME is prioritizing and picking up decedents first at facilities without refrigeration. Attached for your reference is the OCME guidance for completing paperwork for decedent claim case pick up at the nursing home

The Process to follow for NYC OCME with a resident death and subsequent removal of resident remains must receive ONE packet for each decedent to be removed from the nursing home:

Physicians must pre-register in the eVital system.  eVital is New York City’s new electronic reporting system for birth and death records. eVital will replace the Electronic Vital Events Registration System (EVERS) and NYCMED (the log-in health care providers use to access many NYC Health Department online applications).

The physician indicates the cause of death and signs the form for the Death Certificate (DC) and submits the information on the eVital system: eVital@health.nyc.gov

The eVital system will generate both the required Death Certificate and the Burial Permit documents

All the required paperwork listed below must be completed in full and submitted for each decedent case for the OCME to take legal custody.  The nursing home should FAX the following paperwork to the OCME FAX Number: (646) 500-5762

1. Healthcare Facility Resident Face Sheet (contains all of the critical resident information)
2. Completed OCME Clinical Summary Worksheet 3.0
3. The copy of the Death Certificate signed by the physician
4. The Burial Permit completed for City Burial

Important Points to Remember When Contacting OCME for Removal of the Decedent:

1. One packet should be completed and faxed one at a time.  Do not mix several decedents paperwork.
2. Note on the Fax Cover Sheet if the Nursing Home has no refrigeration.
3. Make sure the Fax Cover Sheet has a direct contact and phone number of the Point of Contact at the nursing home so that the OCME investigators can reach them quickly to complete necessary paperwork to expediate the removal.
4. Clinical Worksheet must be filled out completely-include the cause of death.
5. Make sure the entire Death Certificate is submitted when sending the FAX.
6. Do not handwrite anything on the Death Certificate
7. If a packet has been faxed and the nursing home contact has not received a call for further info needed or the status, they should call the OCME main number and state they are from a nursing home and check on the status. If the nursing home has no refrigeration, they need to make that clear.
8. OCME will only accept FAX.  Do not email documents which could be a HIPAA violation.

The USNS Comfort Patient Information Line is 212-246-1210.

April 9th, 2020

NYSDOH – Updated Infection Disease Requisition Form for Collection of Demographic Information

Wadsworth Center has released an updated Infectious Disease Requisition (IDR) form to improve the understanding of demographic patterns of COVID-19 infections.

Laboratories should ensure their order requisition forms include information on both patient sex/gender identity and race/ethnicity, as well as communicate the importance of completing this information to ordering providers.

• 04-09-2020 – NYSDOH – Updated Infection Disease Requisition Form for Collection of Demographic Info

CMS – Trump Administration Acts to Ensure U.S. Healthcare Facilities Can Maximize Frontline Workforces to Confront COVID-19 Crisis

At President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) today temporarily suspended a number of rules so that hospitals, clinics, and other healthcare facilities can boost their frontline medical staffs as they fight to save lives during the 2019 Novel Coronavirus (COVID-19) pandemic.

These changes affect doctors, nurses, and other clinicians nationwide, and focus on reducing supervision and certification requirements so that practitioners can be hired quickly and perform work to the fullest extent of their licenses. The new waivers sharply expand the workforce flexibilities CMS announced on March 30.

• 04-09-2020 – CMS – COVID-19 Testing in LTC

April 8th, 2020

COVID-19 with Nursing Homes

CMS leadership will provide updates on the agency’s latest guidance and will be joined by leaders in the field interested in sharing best practices with their peers. The call will be recorded. Conference lines are limited, so it is highly encouraged you to join via audio webcast, either on your computer or smartphone web browser.

Wednesday, April 8th
4:30 – 5:00 PM EDT 
Attendee Dial-In: 833-614-0820
Conference ID: 6798274
Join via Audio Webcast

April 7th, 2020

Workforce Shortages Survey & Flexibility Options:

The DOH and NYC are utilizing NYSHFAs workforce shortage survey to assist with staffing issues in NYC, Nassau, Suffolk, Westchester, Rockland and Orange Counties. Additionally, the following workforce flexibility options are now available to skilled nursing facilities (please note, items concerning RNs and LPNs are applicable to all providers):

1. CMS has temporarily waived the Training and Certification of Nurse Aids to assist with staffing challenges for a 4 -month interval.
2. Any existing or new staff in a SNF can be trained to feed residents using a shorter feeding program that has a list of competencies that the staff must successfully demonstrate.
3. SNF staff or newly hired staff can be trained to provide CNA functions using a Temporary Nurse Aid program with a competency skills checklist that the such staff must successfully demonstrate.
4. If the staff stays on after the 4-month period, they must meet the full training requirements and competencies to become certified as a CNA and competent as a Paid Feeding Assistant.
5. CNAs whose certification has expired can work during this time.
6. CNA annual in-service requirement timeframe has been extended.
7. CNAs can be rehired who retired or their 2 -year certification has lapsed.
8. CNAs who are certified in other states can work in NYS if they are in good standing on the registry.
9. RNs who are licensed but not registered in NYS can work with a lapsed registration.
10. LPNs, RNs, and Respiratory Therapists who are licensed in another state and in good standing can work in NYS.
11. NYSHFA and AHCA have worked together to provide two programs for free to all SNF:

• A 1-hour online Feeding Assistant program with a test and competency checklist
• An 8 -hour online Temporary Nurse Aid training program with a full competency checklist to validate skills.

Please contact Jackie Pappalardi at jpappalardi@nyshfa-nyscal.org if you have any questions or need any additional information regarding these workforce flexibility options.

NYSDOH Advisory: Hospital Discharges and Admissions to ACFs:

• NYSDOH issued the attached guidance today to clarify expectations for ACFs receiving residents returning from hospitalization and for ACFs accepting new admissions.

NYSDOH: COVID-19 Frequently Asked Questions (FAQs) Regarding Non-Emergency Transportation:

• NYSDOH issued a Frequently Asked Questions (FAQ) guidance today pertaining to non-emergency medical transportation providers in response to the COVID-19 public health emergency.

April 5th, 2020

NYSHFA WORKFORCE SURVEY DUE TODAY AT 3PM

NYSHFA has been asked by the State to assess workforce levels in long term care to help direct staffing resources to facilities in crisis. We know members are anxious about their workforce. It is critically important the data collected in this survey is accurate and to help make quick and accurate decisions to redirect staffing resources to certain facilities as needed.

Please take about 5-10 minutes at most to review your current workforce levels. This survey will close at 3 pm ET on Sunday, April 5th. Please use Saturday, April 4 as the reference date.

COVID-19 EMOTIONAL SUPPORT HELPLINE 1-844-863-9314 Open 8 AM – 10 PM, 7 days a week

The Office of Mental Health has implemented the COVID-19 EMOTIONAL SUPPORT HELPLINE 1-844-863-9314, with an option for callers to indicate they are healthcare worker and/or first responder and will be linked directly to specialized volunteers trained to offer help and support with feelings of anxiety, stress, depression, trauma, and grief. The helpline is open 8 AM – 10 PM, 7 days a week.

• Healthcare Worker Helpline Poster

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.

• 04-04-2020 – NYSDOH – COVID19 LTC Guidance Compilation

CYBER ALERT ISSUED: NYSDOH, Department of Homeland Security and Emergency Services, NYS Intelligence Center

CLICK TO PRINT

A cyber incident is considered a reportable “cybersecurity incident” under the New York State Department of Health guideline, if it affects patient care, or represents a serious threat to patient safety, including intrusions whose intent appears to be breach or theft of protected health records. If your information technology (IT) department suspects a compromise, please contact your local law enforcement and also contact your NYSDOH regional office, per the attached NYSDOH poster, to report the compromise.

This is a substantial threat. If this vulnerability is exploited, remote attackers can execute commands on a targeted device that allows them to gain a foothold inside the targeted networks and establish persistent access, even after the vulnerability has been patched.

• 04-04-2020 – NYSDOH – You’re the Key to Reporting a Cybersecurity Incident … Learn More

IHANS Notification for Nursing Homes, Adult Care Facilities, Hospice Providers and Home Care Agencies

NYSDOH stated that it is imperative that all providers assign at least two individuals capable of meeting the daily deadline and are available to answer any calls from the Department of Health for each of the Health Commerce System roles noted in the attached notification

• 04-04-2020 – IHANS – NYSDOH – Roles for Notification

NYSDOH – Suspension of Health Plan Utilization Review Requirements

This guidance addresses health care provider responsibilities in accordance with the health insurance industry’s suspension of certain utilization review requirements pursuant to the Department of Financial Services Circular Letter No. 8 (2020), and other voluntary reductions and eliminations in authorization requirements.

• 04-04-2020 – NYSDOH_Suspension Health Plan Utilization Review

CMS – 1135 Waivers to Address an Adequate Supply of Workforce Staff and Facilities

The Centers for Medicare and Medicaid Services (CMS) has temporarily waived Training and Certification of Nurse Aides to assist with potential staffing challenges during the COVID-19 pandemic. The following regulations are waived in response to COVID-19: Required retraining; Regular in-service education; 3-Day Prior Hospitalization Reporting Minimum Data Set Staffing Data Submission; Pre-Admission Screening and Annual Resident Review (PASRR); Resident Groups (participate in-person in resident groups); Physician Visits in Skilled Nursing Facilities/Nursing Facilities.

• 04-04-2020 – CMS – 1135 CNA Waiver

NYSDOH – Guidance for Resident and Family Communication in Adult Care Facilities (ACFs) and Nursing Homes (NHs)

NYSDOH strongly encourages nursing homes and assisted living/adult care facilities to implement a communication protocol for both residents and their families, loved ones, and guardians unable to visit the resident during the COVID-19 pandemic. Several best practices to consider when creating a communication protocol are included in the advisory.

April 3rd, 2020

NYSDOH – PPE Short Supply

Healthcare entities should continue to submit requests for PPE through their local Office of Emergency Management. New York State continues to fulfill requests for PPE, as available. However, NYSDOH has become aware of instances in which healthcare providers, facilities, or practices are using or considering alternative means to manage PPE shortages, These contingency and crisis recommendations are based on the CDC guidance and assume that conventional capacity strategies are no longer possible.

• 04.03.2020 – NYSDOH – Options when PPE is in Short Supply or Not Available

AHCA/NCAL – Every Interaction is a Risk

COVID-19 spreads principally person-to-person. Every interaction between people increases the risk of spread, particularly now that the virus is in most areas of the United States.

• 04-03-2020 – AHCA/NCAL Guidance to minimize the number of interactions with residents

CMS Reports Frequent Incorrect Use of PPE

We have heard from CMS that a common theme they are finding during COVID-19 infection control focused surveys are PPE not being used correctly, including donning and doffing procedures. We encourage you to review with your teams the appropriate way to apply and remove all PPE, including gloves, gowns, masks, and eye protection.

• COVID-19 Personal Protective Equipment: Donning
• COVID-19 Personal Protective Equipment: Doffing

CMS Recommendations Include:

• Nursing homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control.
• As nursing homes are a critical part of the healthcare system, and because of the ease of spread in long term care facilities and the severity of illness that occurs in residents with COVID-19, CMS/CDC urges State and local leaders to consider the needs of long term care facilities with respect to supplies of PPE and COVID-19 tests.
• Nursing homes should immediately implement symptom screening for all staff, residents, and visitors – including temperature checks.
• Nursing homes should ensure all staff are using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE.
• To avoid transmission within nursing homes, facilities should use separate staffing teams for residents to the best of their ability, and, as President Trump announced at the White House today, the administration urges nursing homes to work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status.

April 2nd, 2020

NYSDOH – Update on Specimen Collection and HandlingtoAllow Nasal Swab AND Saliva Specimen as Acceptable Alternative Specimen Collection

• 04-02-2020 – NYSDOH – UPDATE: 04-01-2020 Specimen Collection & Handling

Clinical Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)
Thursday, April 2 | 2:00 p.m. –3:30 p.m. (EDT)
Learn more about how to join.

During this COCA Call, clinicians will provide an overview of the clinical characteristics of COVID-19 patients, including case presentations of critically ill adults and clinical management challenges, and summarize recently published guidelines on clinical management of critically ill adults.

April 1st, 2020

Mental Health Resources for Health Care Workers

• NYC Well, which can be reached by calling 1-888-NYC- WELL (1-888-692-9355) or texting “WELL” to 65173.
• Mental Health and Coping During COVID-19 (CDC): https://www.cdc.gov/coronavirus/2019-ncov/about/coping.html
• Taking Care of Your Behavioral Health (SAMHSA): https://www.samhsa.gov/

If you have any questions, please contact NYCEM Health and Medical ESF (HealthMedicalESFList@OEM.NYC.GOV

Requesting PPE:

As your PPE supplies diminish, it is important to conduct an inventory of supplies located in your building to compare with the number of PPE/supplies your staff uses each day over 3 shifts.  Before your supply drops to less than one week supply on-site, please submit your request by phone and email to the Office of Emergency Preparedness (OEM) within your County. Please use the attached NYSDOH Request Form request PPE and/or other supplies needed to submit to your County OEM. Be sure you list a phone number that is answered 24/7 in case your OEM has any follow up questions.

NYSDOH Emergency Contact:

NYSHFA/NYSCAL has been asked by the DOH to stress the importance of the Facility Administrator or the Facility Director to be listed as the 24/7 emergency contact on the Health Commerce System, and to ensure that the appropriate phone numbers and e-mail addresses are up-to-date.

AHCA/NCAL Revised Screening Checklist for Visitors and Staff:

AHCA/NCAL has updated the screening checklist for visitors and staff based on the latest guidance from CMS and CDC. Revisions include changes to Section 3B to reflect when a staff person has worked in facilities or locations with recognized COVID-19 cases, and the staff person has worked with a person with confirmed COVID-19. They should be required to wear PPE including masks, gloves, gown before any contact with residents. Section 4 was also expanded to include CDC guidance for health care provider use of PPE when there are cases of COVID-19 present or not in the facility, as well is in the community. Please replace the prior version of this checklist with this revised version.

CMS ICF/IIDs and PRTFs COVID-19 Guidance Released:

Yesterday, CMS released guidance for infection control and prevention of COVID-19 in Intermediate Care Facilities and for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs).

2:00 pm – AUDIO: NYSHFA | NYSCAL Effective End of Life Communications with Staff and Residents

Effectively communicating to our residents and to our staff is always important for all health care workers but especially this critical knowledge is needed during this COVID-19 pandemic. NYSHFA/NYSCAL is offering a free audio conference on Wednesday, April 1, 2020 at 2:00 pm. See email for call information details provided to all Members this morning. 

4:30 pm – CMS Call with Nursing Homes Later Today

Please join CMS on Wednesday, April 1^st at 4:30 PM EDT for a COVID-19 Call with Nursing Homes. CMS leadership will provide updates on the agency’s latest guidance. There will be audience Q&A and an opportunity for you to share best practices with your peers. The call will be recorded if you are unable to join.

Conference lines are limited, so you are highly encouraged to join via audio webcast, either on your computer or smartphone web browser.

AHCA Accelerated and Advance Payments FAQs

The AHCA Medicare Accelerated and Advance Payment FAQs was developed to supplement the recent CMS Fact Sheet related to this topic. These FAQs are based on preliminary feedback from CMS to member-submitted questions. The Agency will be releasing its own version in the coming days, incorporating additional questions posed by members.

NYSDOH – Health Advisory: Updated Protocols for Personnel in Healthcare and Other Direct Care Settings to Return to Work Following COVID-19 Exposure or Infection

Entities may allow healthcare personnel (HCP) who have been exposed to a confirmed or suspected case of COVID-19, or who have traveled internationally in the past 14 days, whether healthcare providers or other facility staff, to work if all of the following conditions are met:

• 03-31-2020 – NYSDOH – COVID19_Healthcare Personnel Return to Work Update

NYSDOH – Frequently Asked Questions (FAQs) Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency

The intent of this document is to provide additional information regarding the broad expansion for the ability of all Medicaid providers in all situations to use a wide variety of communication methods to deliver services remotely during the COVID-19 State of Emergency, to the extent it is appropriate for the care of the member.

• 03-31-2020 – NYSDOH – Medicaid COVID-19 Telehealth FAQ (002)

CMS – COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers

The Trump Administration is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand the Administration’s aggressive efforts against COVID-19.

• 03-31-2020 – CMS Blanket Waiver Summary Document

• March 31st, 2020
• The Centers for Medicare and Medicaid Services (CMS) has issued several blanket waivers for long term care providers on pages 9-12. The following blanket waivers are in effect, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration.
• Today, the Centers for Medicare & Medicaid Services (CMS) is issuing an unprecedented set of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic.
• Highlights of the temporary actions announced by CMS today:
• Temporary changes apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration.
• Local hospitals and healthcare systems are empowered to:
• 1.   Increase Hospital Capacity – CMS Hospitals Without Walls. Expanding the capacity of communities to develop a system of care that safely treats patients without COVID-19, and isolate and treat patients with COVID-19.
• 2.   Rapidly Expand the Healthcare Workforce. Allowing hospitals and healthcare systems to increase workforce capacity by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community as well as those licensed from other states without violating Medicare rules.
• 3.   Put Patients Over Paperwork. Eliminating paperwork requirements to allow clinicians to spend more time with patients.
• 4.   Further Promote Telehealth in Medicare. Allowing for more than 80 additional services to be furnished to Medicare beneficiaries via telehealth.

March 30th, 2020

Please ONLY use the 718-312-7196 number to contact the Office of Chief Medical Examiner (OCME) until further notice.

Happy National Doctor’s Day!

CMS Accelerated Medicare Payment Policy:

CMS has expanded its Accelerated and Advanced Payment Program to increase cash flow for providers. Specifically, this Program allows providers who bill under Medicare Parts A and B to estimate their Medicare payment for three months in advance with a true-up at a date in the future.

CDC – Coronavirus Disease 2019 (COVID-19) Outpatient Dialysis Facility Preparedness Assessment Tool

All U.S. outpatient dialysis facilities should be prepared for the possible arrival of patients with Coronavirus Disease 2019 (COVID-19). All outpatient dialysis facilities should ensure their staff is trained, equipped, and capable of practices needed to:

03-30-2020 – CDC – COVID-19-outpatient-dialysis

Request for Personal Protective Equipment (PPE)

We have received many questions on the procedure for requesting PPE and/or supplies. As your supplies start to diminish, it is important to conduct an inventory of supplies located in your building to compare with the number of PPE/supplies your staff uses each day over 3 shifts.  Before your supply lowers to less than one week on-site, submit your request by phone and email to the Office of Emergency Preparedness within your County.

If your facility is located within New York City, you must submit the attached form for requesting PPE from the New York City Office of Emergency Management (NYC OEM).

The instructions for nursing homes and assisted living facilities requesting PPE from NYC OEM when they are members of NYSHFA-NYSCAL should send the NYC OEM request form directly to the email listed here with a cc to NYSHFA-NYSCAL:resourcerequest@oem.nyc.gov. The requests are getting filled when the OEM receives shipments.

NYC COVID-19_PPE Request Form

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, 2020

CMS Infection Control Guidance

• Respiratory Line Listing
• Facility Mapping Example
• Instructions for Cleaning Glucometers
  Bleach based products are EPA approved per the CDC for cleaning glucometers. Many glucometers do not have cleaning recommendations because they assume they will be single-use. If there are instructions, it generally refers to cleaning with EPA approved products. With all equipment, please refer and/or call the Manufacturer for directions.
• Linen handling guidance: found under F880
  The facility staff should handle all used laundry as potentially contaminated and use standard precautions (i.e., gloves). Alternatively, if not all used linens are handled as potentially contaminated, staff would provide separation with special identification of bags and containers for contaminated linens with labels, color coding, or other alternative means of separation of the laundry for appropriate handling and processing. The facility should use the following practices:
• Contaminated laundry is bagged or contained at the point of collection (i.e., location where it was used); 58
• Leak-resistant containers or bags are used for linens or textiles contaminated with blood or body substances;58
• Sorting and rinsing of contaminated laundry at the point of use, hallways, or other open resident care spaces is prohibited; and 58
• Staff should handle soiled textiles/linens with minimum agitation to avoid the contamination of air, surfaces, and persons. 58
• INFECTION CONTROL ROUNDS

ACHA/NCAL – Emotionally Supporting Staff

• The COVID-19 pandemic has taken a mental and emotional toll on Americans across the country. Health care workers especially feel the burden of this crisis. Providers must take steps to ensure the health and well-being of their staff as they navigate this challenging time. AHCA/NCAL has compiled resources to help providers prevent burnout and ensure staff feel supported at work.

IHANS ALERT COVID-19 HERDS SURVEY

• NURSING HOMES AND ADULT CARE FACILITIES TO BE COMPLETED BY 1:00 PM 
• RESIDENT RIGHTS REMINDER – Resident rightsrelated to discharge practices have not been waived, That includes the facility’s responsibility related to the transfer and discharge of nursing home residents in accordance with 42 CFR 483.12 and 10 NYCRR 415.3, as they apply to nursing home long term care services and subacute care; and New York State Social Services Law (SSL) 461-g as it applies to adult care facilities (ACFs).
• Prior to any transfer or discharge of any nursing home resident, the nursing home must issue a written “Notice of Transfer or Discharge” to the resident with an opportunity to appeal such Notice. The Notice must include the regulatory basis for the transfer or discharge as specified in 10 NYCRR 415.3.  Please Refer to DAL NH 19-07 Notice of Transfer or Discharge and Permitting Residents to Return – August 20, 2019.
• Any ACF resident who wishes to appeal the operator’s decision to terminate residency must be afforded a special proceeding as provided for under SSL 461-h.

In addition, below is a reminder of the process for PPE requests:

Requests for Personal Protective Equipment (PPE) and supplies must be made as follows:

• Use existing vendor agreements and procurement plans to place orders for quantities needed by type and size of PPE.
• Notify County Office of Emergency Management (OEM) when all existing agreements are exhausted and supply needs exceed those available from these sources.
• Coordinate with County OEM to identify and utilize other existing county resources.
• Notify the respective Department’s Regional Office of ongoing need.
• If all local resources have been exhausted, submit a request to your County OEM, who will communicate needs to the NYS OEM. Requests MUST include:
• o Type and Quantity of PPE by size
• o Point of Contact at the requesting facility
• o Delivery location
• o Date request is needed to be filled by record of pending orders

CDC – Steps to help prevent the spread of COVID-19 if you are sick

• 03-26-2020 – CDC – Sick-with-2019-nCoV-Fact-Sheet

NYSDOH – Specimen Collection and Handling to Include Nasal Swab and Oropharyngeal Swab Specimen Alternative

• 03-26-2020 – NYSDOH – Specimen Collection and Handling

March 25th, 2020

NYSHFA/NYSCAL is working on numerous issues associated with the COVID-19 pandemic. Among the issues we are working on are the following:

• Paid Leave for COVID-19
• Local DSS Approval Processes
• DOH Grants Blanket Extension to Complete ATI Education
• NYSHFA/NYSCAL Town Hall Call
• NYC Surge Space Needed

Paid Leave for COVID-19: NYSHFA/NYSCAL is working with the State and labor counsel to secure further guidance regarding New York’s recently enacted COVID-19 paid sick leave.

DOH Blanket Extension to Complete ATI Education: The DOH is providing a blanket extension for all skilled nursing facilities that have received Advanced Training Initiative (ATI) funds to complete their training initiatives by December 31, 2020. Accordingly, each SNF does not need to request an individual waiver. If you have any questions, please contact Nancy Leveille or Lisa Volk at NYSHFA/NYSCAL.

NYSHFA/NYSCAL Town Hall Call – March 26th: NYSHFA/NYSCAL is hosting a COVID-19 Town Hall call tomorrow at 11:00 am – please see the attached Agenda and dial-in information for tomorrow’s call.

NYC Surge Space Needed: The State is seeking available bed space to address patient surge issues in New York City. Please contact me at shanse@nyshfa.org if you have available space.

NYSDOH Advises Hospital Discharges and Admissions to Nursing Homes

• 03-25-2020 – NYSDOH – NH Admissions and Readmissions

CDC Call on PPE Strategies

CDC will host a Clinician Outreach and Communication Activity (COCA) call that will focus on PPE optimization strategies. The call will take place today, Wednesday, March 25, 2020, from 2:00–3:00 p.m. (Eastern Time). Presenters will discuss strategies for healthcare facilities to optimize PPE supplies such as eye protection, isolation gowns, facemasks, and N95 respirators. Advanced registration is not required. Due to the high demand, we encourage participants to also consider viewing the call on Facebook Live . If you are unable to attend, the call will be available for viewing on COCA’s Facebook page a few hours after the live event ends. If you have questions or would like to learn more about the COCA Call, email coca@cdc.gov.

In addition, we have been notified that today’s COCA call, Underlying Medical Conditions and People at Higher Risk for Coronavirus Disease 2019 (COVID-19), is postponed to March 27, 2020.

AL Hospital Admissions Guidance

AHCA/NCAL has updated our interim guidance regarding accepting hospital discharges during COVID-19 pandemic to include assisted living communities. It is important to note that the decision-making and guidance will likely change as the prevalence of COVID-19 varies in communities and hospital surge increases in the community.

COVID-19 HUD Update

The Office of Healthcare Programs for the Federal Housing Administration has put together a questions and answers document  for external stakeholders around COVID-19. This document addresses questions such as whether the U.S. Department of Housing and Urban Development’s (HUD’s) Office of Healthcare Programs is cancelling or postponing inspections or other site visits in the event of a confirmed COVID-19 case at a HUD-insured facility and what steps Owners and Operators should take to protect residents, staff, and the community. HUD knows long term care providers are looking for supplemental Q&As, and they are working on it daily.

Template Letter to Health Plans and Accountable Care Organizations Requesting Relief

As AHCA previously reported, health plans have announced, and CMS is allowing Medicare Advantage plans flexibilities  to offer, relief to patients and providers specific to COVID-19-related services. However, due to the extraordinary efforts SNF providers are taking to care for all residents, AHCA is providing a template letter to ask Managed Care Organizations (MCOs) for further relief from administrative burdens including all prior authorizations, all pre- and post-payment reviews, excessive documentation requests, and payment delays.

Similarly, AHCA is providing a template letter to use with Accountable Care Organizations (ACOs) to request a reduction in documentation requests, loosening of utilization management strategies and effective communication and partnership on COVID-19 patients.  To use the letters, download the document(s) and include the MCO’s or ACO’s name and SNF’s contact information where indicated, and send the letter to the provider or contract representative at the MCO or ACO.

Possible Extension of Medicare Cost Report Due Date

With the considerable burden posed by COVID-19, SNFs have been exploring as many possible ways to reduce administrative burden and free up staff.  A key question has been whether CMS would extend cost report due dates.  Today, at least one Local Administrative Contractor (MAC) posted information indicating CMS has the authority to extend cost reporting due dates (42 CFR § 413.24 (f) (2) (ii)).

Specifically, the MAC noted that CMS will delay the filing deadline of Fiscal Year End (FYE) December 31, 2019 cost reports due at the end of May due to the COVID-19 outbreak.

The filing deadline for the following cost reports are now June 30, 2020:

• FYE October 31, 2019 due by March 31, 2020
• FYE November 30, 2019 due by April 30, 2020

The filing deadline for FYE December 31, 2019 is now July 31, 2020.
Suggested Action Steps:

1. Check your MAC Provider Information webpage for similar information; or
2. If none is posted, contact your MAC and ask about the dates, above.  MAC often do not follow the same procedures and post differing information.

View a map of MAC coverage by states.

March 24th, 2020

NYSHFA/NYSCAL continues to have numerous discussions with the Governor’s office and the DOH regarding many issues affecting providers associated with the COVID-19 pandemic. Among the issues we are working on are the following:

1. DOH: Updated COVID-19 Medicaid Update Special Edition: Comprehensive Telehealth Guidance 3-23-2020
2. CMS Announces Findings at Kirkland Nursing Home and New Targeted Plan for Healthcare Facility Inspections in light of COVID
3. COVID-19 Reminder: Ensure Access to Health Care Proxies, Non-Hospital DNRs and MOLST in Adult Care/Assisted Living Facilities
4. 1135 Waiver Request
5. Hydroxychloroquine & Chloroquine
6. Live Free Webinar by RPA a Jensen Hughes Company:  How to Prepare your Facility for Surge
7. COVID-19 and Infection Control videos for Nursing Homes and Healthcare Facilities

DOH: Updated COVID-19 Telehealth Guidance:  Attached please find an updated version of the Medicaid Update Special Edition – Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency, which now includes clarifications for FQHC billing as well as billing for home care providers.

CMS Announces New Targeted Plan for Healthcare Facility Inspections: CMS is prioritizing and suspending certain federal and SSA surveys, and delaying revisit surveys, pursuant to federal requirements for the next three weeks for all certified provider and supplier types. CMS released guidance which includes which types of surveys that will be prioritized and conducted. Also included is a survey tool that will be used for the targeted infection control surveys which is found at the end of the guidance document. See link for fullguidance.

Ensure Access to Health Care Proxies, Non-Hospital DNRs and MOLST in Assisted Living Facilities:  This is a reminder for adult care/assisted living facilities (ACF/ALs) with respect to maintaining access to and transferring health care proxies, non-hospital DNRs, and/or Medical Orders for Life Sustaining Treatment (MOLST) of your residents in the event of an emergency or transfer to a different setting.

The following are our Proposed Action Steps:

1. Review your policies and procedures for residents who have acute or emergent care needs that require EMS or a transfer to a hospital or other facility. Ensure your policy includes staff access to those documents and the procedure to pass them on to the emergency health care provider;
2. Ensure that any health care proxies, non-hospital DNRs, and/or MOLST orders are accessible to appropriate staff in the event of an emergency or transfer and train staff accordingly; and
3. MOLST orders, non-hospital DNRs, and/or health care proxies should be transferred with residents when they go to a hospital or other setting.  When residents are admitted or return from a hospital or other setting, with a non-hospital DNR, MOLST orders and/or health care proxy, it should be maintained in the resident record.

1135 Waiver Request: New York submitted it 1135 Waiver Request to CMS yesterday evening. NYSHFA/NYSCAL worked closely with the State on the promulgation of this request and will be sure to notify you when the final version is approved by CMS.

Hydroxychloroquine & Chloroquine: NYSHFA/NYSCAL is working with the Governor’s office to exempt skilled nursing facilities from the Governor’s prohibition against a pharmacist dispensing Hydroxychloroquine or Chloroquine except when written as prescribed for an FDA-approved indication or as part of a State approved clinical trial for a patient who has tested positive for COVID-19. Additionally, NYSHFA/NYSCAL anticipates the FDA authorizing the off-label use of Hydroxychloroquine to aid in the care of COVID-19 infected patients.

COVID-19 and Infection Control Videos for Nursing Homes and Healthcare Facilities

The Audacia Foundation has developed and launched a videos series focusing on COVID-19 and Infection Control in Nursing Homes and Healthcare Facilities.  Click on the links below to view and feel free to share as appropriate.

• Donning and Doffing of Personal Protective Equipment (PPE)
• Hand Hygiene
• The Audacia Foundation YouTubeChannel

CMS Announces Findings at Kirkland Nursing Home and New Targeted Plan for Healthcare Facility Inspections in light of COVID

The Centers for Medicare & Medicaid Services (CMS) is announcing the preliminary results of a recent inspection of the Life Care Center nursing home in Kirkland, Washington – the epicenter of the 2019 Novel Coronavirus (COVID-19) outbreak in that state. CMS is prioritizing and suspending certain federal and SSA surveys, and delaying revisit surveys, pursuant to federal requirements for the next three weeks, beginning March 20, 2020, for all certified provider and supplier types. CMS released guidance which includes which types of surveys will be prioritized and conducted. Also included is a survey tool that will be used for the targeted infection control surveys which are found at the end of the guidance document. See full guidance.

• Press Release
• Fact Sheet 
• Talking Points
  

Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency

The intent of this guidance is to provide broad expansion for the ability of all Medicaid providers in all situations to use a wide variety of communication methods to deliver services remotely during the COVID-19 State of Emergency, to the extent, it is appropriate for the care of the member.

This guidance replaces previously issued guidance regarding telehealth and telephonic communication services during the COVID-19 State of Emergency

• 03-23-2020 – NYSDOH – SPECIAL EDITION: Medicaid Comprehensive Telehealth Guidance

March 23rd, 2020

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.

• 03-23-2020 – NYS – GUIDANCE ON EXECUTIVE ORDER 202.6

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).

• 03-23-2020 – CMS OPEN DOOR FORUM

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.

• 03-23-2020 – ACHA – SNFs Accepting Admissions from Hospitals

Guidance Regarding ACF Operations During COVID-19 Outbreak

In response to inquiries received to date, the Department provides the following guidance:

• 03-23-2020 – NYSDOH – ACF COVID-19 Guidance

March 22nd, 2020

Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential Coronavirus Disease 2019 (COVID-19) Exposures: Geographic Risk and Contacts of Laboratory-confirmed Cases

Recommendations in this document for actions by public health authorities apply primarily to US jurisdictions that are not experiencing sustained community transmission. CDC will provide separate guidance for US jurisdictions with sustained community transmission.

• 03.22.2020 – CDC – Updated Assessment and Public Health Management of COVID-19 Potential Risk Exposure

Medicaid Update — Special Edition

Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency

• 03-22-2020 – NYSDOH – Medicaid Update COVID-19 Telephonic and Telehealth

COVID-19 Guidance to Transportation Managers and Brokers

• 03-22-2020 – NYSDOH – COVID-19 Transportation Guidance

COVID-19 Guidance for SNF Seeking Emergency Approval

• 03-22-2020 –NYSDOH –  This guidance is intended for Skilled Nursing Facilities (SNF) seeking emergency approval from the New York State Department of Health (the Department) for temporary provision of Home Hemodialysis (HHD) services to nursing home residents. Click to learn more …

AHCA/NCAL – Communicating After a Confirmed Case and Further Guidance …

• Click to learn more …

March 21st, 2020

Beware COVID-19 Scams Selling PPE or Other Supplies

Providers are receiving vendor emails or other contact offering PPE supplies, and some may not be legitimate vendors or businesses. Please beware that some offers are scams and are not credible businesses. To help you spot the difference between legitimate businesses and scams, the Federal Trade Commission (FTC) has provided some general guidance on COVID-19-related scams. AHCA/NCAL has also compiled a list of helpful questions to ask yourself and the business in question.

NYSHFA | NYSCAL — “#Love Pic”

In this time of unprecedented stress, anxiety, and uncertainty, it is crucial to remember that we are ALL in this together – staff, residents, and families – each and every one of us!

When we are facing so many seemingly overwhelming issues at work and in our personal lives, it can be extremely difficult to notice all the moments of love, compassion, and joy that are occurring regularly within our facilities. But these moments are occurring all around us! If we strive to seek out these moments of love, compassion, and joy, we will find them!

The photo below is just one example of the love and joy that is all around us. I am asking each and every member of our NYSHFA/NYSCAL family to actively seek out these moments at your facility, take a “LOVEpic” photo with a phone (with no associated words or names) or have a resident or family member share a photo and e-mail it to Jessica Van Wormer at jvanwormer@nyshfa-nyscal.org for posting on our website.

In life, great things are done by a series of small things brought together. Through our care and compassion in serving others, we serve ourselves. 

States Actions to Provide Childcare for Health Care/Essential Workers 

AHCA/NCAL has collected some information on how states are handling childcare for healthcare workers and other essential employees.

Resident Laundry Guidance with COVID-19 and When Families Want to Do Residents’ Laundry

With the restriction around non-essential visitors to skilled nursing centers and assisted living communities to minimize the risk of spread of COVID-19, there have been many questions on handling residents’ personal laundry, including for those who may have previously had their laundry done by a family member.

AHCA/NCAL has developed some additional guidance on this. You can also follow CDC guidelines for environmental infection control in healthcare facilities . CDC states that “Infection has not been linked to laundry procedures in residential-care facilities, even when consumer versions of detergents and laundry additives are used.”

March 19th, 2020

Recommendations to Support Resident Physical Health

• 03.20.2020 – NYSDOH – NH Protecting Residents

NYSDOH – Guidance on the Contacts of a Close or Proximate Contact of a Confirmed or Suspected Case of COVID-19

• 03-19-2020 – NYSDOH GUIDANCE ON POSSIBLE CONTACTS OF COVID-19

March 18th, 2020

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.

CMS 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 Overview of Waiver

CDC Guidance on Use of Masks, Gowns, and Eye Protection to Conserve Supplies

Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19)

March 17th, 2020

March 14th, 2020

NATIONAL EMERGENCY DECLARED:
CMS Restricts all SNF Visitors Except End-of-Life Situations

March 13th, 2020

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.

• 03-12-2020 – NYSDOH – NH Guidance Resident and Health Care Personnel

March 12th, 2020

DAL – ADULT CARE FACILITIES

The New York State Department of Health (NYSDOH) is providing this guidance regarding precautions and procedures adult care facilities (ACFs) should take to protect and maintain the health and safety of their residents and staff during the ongoing novel coronavirus (COVID-19) outbreak.

• DAL  – Click for more details …

DAL – NURSING HOMES

The New York State Department of Health (NYSDOH) is providing this guidance regarding precautions and procedures nursing homes must take to protect and maintain the health and safety of their residents and staff during the ongoing novel coronavirus (COVID-19) outbreak.

• DAL – Click for more details …

March 11th, 2020

• Environmental infection control practices are essential to reduce the risk of the virus entering nursing centers and assisted living communities.  Click for more details …
• The NYSDOH & OPCHSM have extended the compliance period for providers to complete the work required until April 30, 2020.  Click for more details …
• CMS provides flexibility to Medicare Advantage and Part D plans to waive unnecessary barriers that could prevent access to care.  Click for more details …

CLICK TO PR

This is to advise all nursing homes and adult care facilities statewide that the NYS Department of Health (NYSDOH) is requiring the completion of HERDS survey by 3pm daily with no exceptions until further notice.

March 9th, 2020

March 7th, 2020

FAQs for Health Care Providers Click Here

Included in the FAQs are:

• Guidance on how to bill and receive payment for testing patients at risk of COVID-19;
• Details of Medicare’s payment policies for laboratory and diagnostic services, drugs and vaccines under Medicare Part B, ambulance services, and other medical services delivered by physicians, hospitals, and facilities accepting government resources; and
• Information on billing for telehealth or in-home provider services. Since 2019, the Trump Administration has expanded flexibilities for CMS to pay providers for virtual check-ins and other digital communications with patients, which will make it easier for sick patients to stay home and lower the risk of spreading the infection.

March 6th, 2020

CMS Develops Additional Code for Coronavirus Lab Tests

Agency Issues Fact Sheets Detailing Coverage under Programs.

• CMS Develops Additional Code for Coronavirus Lab Tests-3-6-2020

March 5th, 2020

CMS calls on all health care providers to activate infection control practices and issues guidance to inspectors as they inspect facilities affected by Coronavirus.

• 03-05-2020 – CMS Announces Actions for SNF-AL Facilities

ADDITIONAL RESOURCES:

March 4th, 2020

Coronavirus disease (COVID-19) is spreading globally with instances of COVID-19 community spread in the United States. The general strategies CDC recommends to prevent the spread of COVID-19 in healthcare are the same strategies these facilities use every day to detect and prevent the spread of other respiratory viruses like influenza.

• 03-04-2020 – CMS Coronavirus Guidance for SNF-AL Facilities-3-4-2020