COVID-19

CDC – PPEs Guidance »NYS Emergency Mgmt Offices » Request for Supplies Screening Checklist for AL/SNF

Skilled Nursing Facility Visitation Guidance Assisted Living Community Visitation Guidance

Template Letter to Employees Template Letter to Family Talking Points for Facilities Without COVID-19


August 2nd

NYC Emergency Management is closely monitoring Hurricane Isaias for any potential impacts to NYC early this week.


JULY 22nd

PPE New York State Stockpile Requirement

NYSHFA|NYSCAL had a call with the Governor’s leadership team and the Commissioner of Health today regarding their concerns of a potential COVID-19 spike occurring in concert with the upcoming flu season beginning on September 1st. Consequently, the State is requiring all skilled nursing facilities to have a 60-day supply of PPE on hand by August 31st and a 90-day supply of PPE on hand by September 30th. Such PPE includes N-95 masks, surgical masks, gowns, face shields and gloves.

The State is calculating each facility’s PPE supply figures based on data reported on the HERDS Survey during the time period of April 13th – April 21st of this year. Tomorrow’s HERDS Survey will likely include additional questions related to the State’s PPE “stockpile” requirement. Facilities that face PPE storage constraints will be able to indicate that fact on the HERDS Survey and the State will assist. Additionally, the State will be promulgating an emergency regulation setting forth its PPE stockpile requirement. While hospitals are also required to stockpile PPE, the State has indicated that assisted living providers will not be required to stockpile PPE at the present time, however, this could change depending on future circumstances concerning the COVID-19 pandemic.

NYSHFA|NYSCAL will continue to keep you updated as this matter progresses.


State Executives, State Affiliate Staff & State ED Directors

AHCA/NCAL has released three new resources to help long term care providers and staff during the COVID-19 pandemic.  These products fall into three categories of availability, including free and available to all long term care staff and the public, free for AHCA/NCAL members, and one resource that can be purchased by members and non-members.  State Affiliates automatically receive a 40% royalty on all net revenue AHCA/NCAL receives on sales of the for-purchase resource in their respective states.

New Resource #1 Available for Purchase

The Infection Prevention and Control in the Post-COVID-19 World online course reviews how COVID-19 spreads, how to track and report the illness, and describes the regulatory requirements for infection prevention and control. The basics of infection prevention and control practices are discussed as is the future of infection prevention and control.

The course also describes the process for cohorting and utilizing testing to inform cohorting practices.  It explains how to conduct self-assessment processes to continually evaluate and improve the infection prevention and control programs in long term care centers.  Lastly, the course reviews the process and necessity of screening practices and notifications to residents, families, and their representatives including the importance of communication.

The audience for Infection Prevention and Control in the Post-COVID-19 World  is Nurses, Administrators, and Nursing Home Leadership/Management (Clinical & Non-Clinical Leaders).  NAB will award 3.0 CEs upon successful completion of a quiz, and the Iowa Board of Nursing has approved 3.0 contact hours upon successful completion of a quiz.  The cost of the course is $199 for AHCA/NCAL members or $249 for non-members.

New Resource #2 Available to All Staff/General Public for Free

The second training, titled Basics of Infection Prevention and Control in the Post-COVID-19 World, is free and designed for all nursing home staff members.  This course will review how COVID-19 spreads, what the signs and symptoms of COVID-19 are, and how to report the illness.  It reviews staff members’ roles in reporting suspicions of respiratory illness.  The online course also reviews the basics of infection prevention and control practices, including the future of infection prevention and control. This program has open access and is free and available to AHCA/NCAL members, non-members and the general public.

New Resource #3 Available Free to AHCA/NCAL Members

AHCA/NCAL has developed a series of “Member Only”  Infection Prevention and Control Action Briefs to help centers develop and improve their infection prevention and control programs.  Action briefs are designed to be quick references to help long-term care providers with meaningful implementation and tips. This resource includes six action briefs that focus on five key areas in responding to the COVID-19 pandemic:

  • Introduction: The Infection Prevention and Control Program/Core Practices Connection
  • Self-Assessment
  • Communication and Documentation
  • Cohorting and Testing
  • Fostering Social Connections
  • Supporting Staff Wellness

Each action brief combines two key concepts – infection prevention and control and core practices. Infection prevention and control (IP&C) is an essential component of care in all long-term care centers. Vital to the success of IP&C programs is a set of core practices that are the foundational building blocks for success in every aspect of resident care.

Core practices are a set of principles that revolve around providing reliable, person-centered care and doing the right thing in the right way. High performing health care systems are distinguished by a set of underlying core practices that allow them to effectively put systems in place for reliable care. Implementation of core practices will help make facility infection prevention and control programs more effective.

The ahcancalED infection prevention and control resources can be found here.


JULY 20th

NYSDOH Testing and Reporting of Mosquito and Tick-Borne Illnesses


JULY 10th

NYSDOH SNF Visitation Guidelines

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

CMS Directs Additional Resources to Nursing Homes in COVID-19 Hotspot Areas

The Centers for Medicare & Medicaid Services (CMS) announced the agency’s targeted approach to provide additional resources to nursing homes in coronavirus disease 2019 (COVID-19) hotspot areas.  Specifically, CMS plans to deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in the hotspot areas as identified by the White House Coronavirus Task Force. QIOs are CMS contractors who work with healthcare providers to help them improve the quality of healthcare they provide to Medicare Beneficiaries. In addition, the agency is implementing an enhanced survey process tailored to meet the specific concerns of hotspot areas and will coordinate federal, state and local efforts to leverage all available resources to these facilities. The purpose of these efforts is to target facilities with known infection control issues by providing resources and support that will help them improve quality and safety and protect vulnerable Americans.

Nursing homes are especially vulnerable to the prevalence and spread of COVID-19.  Additional resources are needed to ensure nursing homes take proactive steps to enhance infection control policies and practices to limit potential transmission and prevent widespread outbreaks within these facilities.

This is part of the Administration’s ongoing efforts to protect the health and safety of nursing home residents across the country during the public health emergency.


JULY 8th

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

Amid the ongoing COVID-19 pandemic, the New York State Department of Health (NYS DOH) continues to monitor the situation and work to expand COVID-19 diagnostic and serologic testing for New Yorkers. This updates the guidance issued on May 31, 2020.

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

Please distribute immediately to:

Administrators, Infection Preventionists, Hospital Epidemiologists, Medical Directors, Nursing Directors, Risk Managers, and Public Affairs.


JUNE 15th 

NEW! Health Equity and COVID 19: Mitigating Impacts on Minority Populations

June 18, 2020 (10:30am – 11:00am)
WEBINAR
Register Here
POC: QI IPRO

NEW! National Nursing Home Training Series – Clinical Care: Managing COVID Positive Residents

June 18, 2020 (4:00pm – 5:00pm)
WEBINAR
Register Here

POC: QI IPRO

National Nursing Home Training Series

Invitations are distributed weekly for each training in the series. Sign up here for updates. Miss a training? View recordings, slides and resources on QIOProgram.org


Update #79 – AHCA/NCAL

CMS Issuing Citations and CMPs for Failure to Report COVID-19 Data

This week, CMS began issuing 2567s with F level citations for F884 with a $1,000 per instance civil monetary penalty (CMP). These are being issued to all SNFs identified by CMS from data transmitted by CDC as not having submitted data or submitting incomplete or otherwise erroneous data for the week of June 1 to June 7.

The notifications of deficiency and CMP are being sent via the CASPER/QIES system (not the traditional method for notifying a facility with a deficiency). Thus, facilities must log in to CASPER to see if they have a citation or not.

READ MORE

Other COVID-19 Updates

New FAQs for ICFs/IID: On June 10, CMS released new FAQs (pages 13-15) for intermediate care facilities for individuals with intellectual or developmental disabilities related to COVID-19. Read More

Coalition Submits Request to Extend Therapy Telehealth Waivers: On June 10, AHCA/NCAL and 13 other therapy advocacy organizations submitted a letter to HHS Secretary Azar, CMS Administrator Verma, and other key CMS officials requesting extension of COVID-19 therapy telehealth waivers as well as efforts to make these policies permanent in law. Read More

COCA Webinar for Tuesday, June 16: the CDC Clinical Outreach and Communication Activity (COCA) will be hosting a webinar on applying COVID-19 infection prevention and control strategies in nursing homes. Read More

Update #80 – AHCA/NCAL

Update on NHSN Reporting and Related Citations & Fines

AHCA received communication from CMS late last night (June 11) regarding reporting through the National Healthcare Safety Network (NHSN). CMS is researching the issues resulting in providers being marked as non-compliant.

CMS reports that there are a few common issues they have discovered so far, and the agency is seeking each center’s help to get these corrected and straightened out. The Centers for Disease Control and Prevention’s (CDC) NHSN is looking into some actions that they can take to make it easier for these issues to be identified on the facility side of the platform.

Update on NHSN Reporting and Related Citations & FinesAHCA received communication from CMS late last night (June 11) regarding reporting through the National Healthcare Safety Network (NHSN). CMS is researching the issues resulting in providers being marked as non-compliant.CMS reports that there are a few common issues they have discovered so far, and the agency is seeking each center’s help to get these corrected and straightened out. The Centers for Disease Control and Prevention’s (CDC) NHSN is looking into some actions that they can take to make it easier for these issues to be identified on the facility side of the platform.READ MORE

Other COVID-19 Updates

Webinar: Providers Share Their Experiences with COVID-19 Telehealth Waivers: AHCA/NCAL has posted a 45-minute webinar on ahcancalED in which four members (from independent owners to large multistate for-profit and nonprofit organizations) share their experiences in implementing the COVID-19 telehealth waivers, and how the waivers have helped improve care during the public health emergency. The webinar is free to AHCA/NCAL members and is viewable on-demand. Read More


JUNE 10th 

NYS Aware Prepare Newsletter for Education

NYS released the Mid-Month June 2020 issue of the Aware Prepare (AP) Update. The AP is a bi-monthly guide to upcoming trainings related to preparedness, readiness, and response. These trainings may be provided in one or more of the following formats, including: live webcasts, webinars and in-person training; archived webcasts, webinars and on demand eLearning. Questions or submissions, email: edlearn@health.ny.gov


Support Your Frontline Staff

Now more than ever, your staff need to be given the tools to provide the best care possible for people living with dementia.

As COVID-19 continues to impact the way care is given throughout the country, people living with dementia are at an increased risk of hospitalization.

Relias offers an in-depth library of advanced dementia care training from experts like Teepa Snow. Our courses are designed to give your caregivers the tools they need to provide the best care for your residents. Relias dementia care training can help you:

  • Provide care for all stages of dementia
  • Reduce risk caused by inconsistent care
  • Alleviate the stress and uncertainty associated with treating memory care patients

Speak to a representative to receive a personalized demonstration of our dementia care training offering.

REQUEST A DEMO

 


JUNE 9th 

CMS Issued New In-Person Treatment Recommendations As Guidance to Health Systems and Individuals As COVID-19 cases Decline

CMS is providing these recommendations to ensure that non-emergency healthcare resumes safely and that patients are receiving needed in-person treatment that may have been postponed due to the public health emergency. To aid patients in making a decision that is right for them, CMS issued recommendations to help guide patients as they consider seeking in-person, non-emergency treatment.

Trump Administration Encourages Reopening of Healthcare Facilities

New recommendations provide guidance to health systems and patients as COVID-19 cases decline

Today, under the direction of President Trump, the Centers for Medicare & Medicaid Services (CMS) released a guide for patients and beneficiaries as they consider their in-person care options. During the height of the pandemic, many healthcare systems and patients postponed non-emergency, in-person care in order to keep patients and providers safe and to ensure capacity to care for COVID-19 patients. As states and regions across the United States see a decline in cases of COVID-19, CMS is providing these recommendations to ensure that non-emergency healthcare resumes safely and that patients are receiving needed in-person treatment that may have been postponed due to the public health emergency.

“Thanks to President Trump’s unprecedented expansion of telehealth, many patients have been able to access their clinicians while staying safe at home.  But while telehealth has proven to be a lifeline, nothing can absolutely replace the gold standard: in-person care,” said CMS Administrator Seema Verma. “Americans need their healthcare and our healthcare heroes are working overtime to deliver it safely. Those needing operations, vaccinations, procedures, preventive care, or evaluation for chronic conditions should feel confident seeking in-person care when recommended by their provider.”

On April 19, CMS issued Phase 1 recommendations to safely resume in-person care in areas with low incidence or relatively low and stable incidence of COVID-19 cases. CMS is also providing more information as healthcare systems, providers, and facilities further expand in-person care delivery. Recommendations cover a range of topics to ensure patient and clinician safety, including facility considerations, testing and sanitation protocols, personal protective equipment and supplies, and workforce availability. As with Phase 1 recommendations, decisions to reopen should be consistent with federal, state, and local orders, CDC guidance, and in collaboration with state and local public health authorities.

As the country continues to reopen, patients have questions about when to resume in-person visits with their clinicians. To aid patients in making a decision that is right for them, CMS issued recommendations to help guide patients as they consider seeking in-person, non-emergency treatment. Ultimately, patients should rely on their providers’ suggested course of treatment.

Today’s recommendations can be found here: https://www.cms.gov/files/document/covid-recommendations-reopening-facilities-provide-non-emergent-care.pdf

The new patient guide can be found in English here: https://cms.gov/files/document/covid-what-patients-should-know-about-seeking-health-care.pdf and in Spanish here: https://www.cms.gov/files/document/covid-what-patients-should-know-about-seeking-health-care-spanish.pdf

To keep up with the important and ongoing work of the White House Coronavirus Task Force in response to COVID-19, visit www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.


June 7th, 2020

CMS Nursing Home COVID-19 Data Submitted as of Week Ending: 05/31/2020


June 5th, 2020

CMS – Post’s Memo – Enhanced Enforcement for Infection Control deficiencies in Nursing Homes:

Included in this memo are COVID -19 Survey Activities, Expanded Survey Activities , Enhanced Enforcement for Infection Control Deficiencies and QIO support. NYSHFA has the CMS Survey Infection Control Tools posted on website and are available for you to prepare for these surveys.

See full  QSO-20-31 memo here: https://www.cms.gov/files/document/qso-20-31-all.pdf


June 4th, 2020

CMS – COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement Activities in Nursing Homes Memo:

Included in this memo are COVID -19 Survey Activities, Expanded Survey Activities , Enhanced Enforcement for Infection Control Deficiencies and QIO support. NYSHFA has the CMS Survey Infection Control Tools posted on website and are available for you to prepare for these surveys.

See full  QSO-20-31 memo here: https://www.cms.gov/files/document/qso-20-31-all.pdf


June 3rd, 2020

NYSDOH Announcement: Test kits to be delivered

This message is to inform you that all nursing homes and adult care facilities that indicated a need for additional COVID-19 test kits for the purpose of testing staff at these facilities in last week’s survey, will receive a shipment on Wednesday, June 3, 2020.

Update #75 – AHCA/NCAL

Updates to Provider Relief Fund FAQs Address TIN and Gross Receipts

Late yesterday, June 2, HHS released updated FAQs with long awaited guidance on Tax Identification Numbers (TIN) and has explained use of Gross Receipts. In addition to the TIN FAQs, HHS also added or updated other FAQ topic areas.  That information is listed below the TIN information. To find updated, Gross Receipts language, AHCA/NCAL recommends downloading a copy of the FAQs as a PDF and conducting a key word search.

Revised Notification Guidelines

AHCA/NCAL has updated the COVID-19 Reporting and Notification Guidelines for Nursing Homes, according to the new regulations for notifying residents, representatives and families of COVID cases that went into effect on May 8, 2020. These guidelines supplement the information in this detailed summary AHCA previously provided  and provide further clarification from CMS on how providers should report cumulative COVID cases and clusters of three or more residents/staff with new onset respiratory symptoms within 72 hours. Read More


June 2nd, 2020

NYSHFA was on a call with DOH this evening to discuss the DOH’s SNF/ACF week three testing survey which will be out tomorrow. The Department of Health is hosting a webinar tomorrow, June 3rd at 10:00 a.m. for adult care facilities and nursing homes regarding updates to the weekly Nursing Home and Adult Care Facility testing survey related to measures taken by the facility to meet the terms of Executive Order #202.30 and specifically staff testing.

There has been some modifications to the survey such as Section 1 and 6. There is now a certification included in section 6 regarding Executive Order #202.30. If you as the authorized representative agree with the certification you would select yes. If you do not believe your facility is in compliance select no and type the reason as to why the facility is not in compliance. As with any certification you may want to review with your legal counsel. The survey will be due by Thursday, June 4th at 5:00 pm

DOH plans to conduct surveys each week which will include the last week’s data and cumulative data as the weeks progress. They highlighted the need for providers to keep testing logs each week. Providers can print off/save your data as you complete the surveys prior to submitting. You cannot go back into the database after you submit. We encourage all providers to listen to the Seminar tomorrow for full information.

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


June 1st, 2020

CDC Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes


May 31st, 2020

IHANS ALERT COVID-19 HERDS SURVEY NURSING HOMES, ADULT CARE FACILITIES, HOSPICES & CERTIFIED HOME HEALTH AGENCIES TO BE COMPLETED BY 1:00 PM

The Daily COVID-19 Survey is used to capture data necessary to help the Department policy decisions including the allocation of valuable resources. The daily survey is due by 1:00pm every day, seven days per week.

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 following Health Commerce System roles:

ACFs, Hospice & Home Care Agencies:

  • Administrator
  • Data Reporter
  • Director of Resident Services/Director of Patient Services
  • Emergency Response Coordinator
  • HPN Coordinator

Nursing Homes:

  • Administrator
  • Director of Nursing
  • Data Reporter
  • Director of Patient Services
  • Emergency Response Coordinator
  • HPN Coordinator

Inquiries related to COVID-19 may be referred to the following program-specific email addresses:

covidadultcareinfo@health.ny.gov ; covidnursinghomeinfo@health.ny.gov ; and covidhomecareinfo@health.ny.gov.

Please be reminded that all Providers MUST continue to request PPE using the process below. It is imperative to provide accurate and timely daily information for PPE on the HERDS survey:

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:
  1. Type and Quantity of PPE by size
  2. Point of Contact at the requesting facility
  3. Delivery location
  4. Date request is needed to be filled by record of pending order.

NYSDOH HEALTH ADVISORY: Symptom-based Strategy to Discontinue Home Isolation for Persons with COVID-19

NYSDOH issued a Health Advisory providing updated guidance on releasing individuals from home isolation as a result of COVID-19 illness. The information contained herein supersedes NYS DOH guidance issued on March 28, 2020, and is not intended to be applied to settings such as nursing homes, assisted living facilities, or adult care facilities.

For questions: Please send an e-mail to bcdc@health.ny.gov, as notify01 is a non-monitored mailbox.


May 28th, 2020

Infection Control Checklist

AHCA/NCAL UPDATE #72

Testing and Cohorting: When & How?

Trying to figure out what to do about testing and cohorting can be a challenge. AHCA has created an algorithm for testing and cohorting nursing home residents which incorporates the latest CDC guidance. The algorithm walks through three primary entry points for testing prior to deciding on who and how to cohort individuals. The entry points include testing residents who develop symptoms, testing all residents simultaneously, and testing new admissions. The algorithm also walks through how to cohort if the person(s) tested are in a single-person room or with roommates.

Innovative Methods to Keeping Residents Connected

AHCA/NCAL has prepared a resource to help providers continue to keep residents connected to their loved ones. As visitation restrictions and social distancing continues, we need to find ways to keep people connected in-person when possible. Using an infection prevention and control mindset can help generate innovative methods to engage residents and families and fellow residents.

This resource is a starting point and intended to kick off additional ideas each center or community is able to try based on the status of COVID-19 in their building and in their community as well as the availability of necessary resources to support these innovative efforts. This resource can be used by nursing homes, assisted living communities and ICF/IID as each sees fit.

Revised 1135 Waiver Template for Nursing Homes

In our guidance on Where to Turn for Help, AHCA/NCAL shared information on and a customizable template for requesting a facility-level 1135 waiver. AHCA/NCAL has updated the template due to CMS blanket waivers and guidance provided since we first shared the template.

Remember that while using this check-box format it is still important that you customize your waiver request to reflect your center’s needs and circumstances, as this will aid in CMS’s review and approval of your requests. This is a Word document, so you can make edits to include the items you need and to provide any additional explanation or rationale for your requests.

CDC Website Updates

On May 19, the Centers for Disease Control and Prevention (CDC) updated several of their webpages to be reflective of the Centers for Medicare & Medicaid Services (CMS) updates on reopening guidance. The three webpages that were updated include:

Below is a summary of what was changed. Review your infection prevention & control procedures to ensure they are consistent with the latest guidance.

  • Tiered recommendations to address nursing homes in different phases of COVID-19 response
  • Added a recommendation to assign an individual to manage the facility’s infection control program – this is new. CDC strongly feels that “Facilities should assign at least one individual with training in IPC to provide on-site management of their COVID-19 prevention and response activities”, because of the breadth of activities for which an Infection Prevention & Control (IPC) program is responsible, including developing IPC policies and procedures, performing infection surveillance, providing competency-based training of HCP, and auditing adherence to recommended IPC practices.
  • Added guidance about new requirements for nursing homes to report to the National Healthcare Safety Network (NHSN)
  • Added a recommendation to create a plan for testing residents and healthcare personnel for SARS-CoV-2. Note, AHCA/NCAL provided recent guidance on testing which incorporate the latest from CDC.
  • Additional descriptive information for certain areas like universal source control, hand hygiene, optimization of PPE, and the COVID unit section based on common questions received including:
    • Removed language to move residents with symptoms or suspect COVID to an observation unit, if one was available, as this has been a point of confusion and has not been feasible for most facilities.
    • CDC recommends creating a COVID unit for residents with confirmed COVID and, if possible, an observation area for new admissions with no known COVID history (those with known COVID would go to COVID unit), but recommend that if possible those with symptoms or suspect COVID-19 go to a private room. Testing should be prioritized for these individuals and, if positive, they would move to a COVID unit. PPE should be worn.

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.


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:

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

  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

CMS Issues Nursing Home Reopening Recommendations for State and Local Officials

Today, CMS provided recommendations on a nursing home phased reopening for states. The recommendations cover the following items:  

  • Recommendations for testing residents and staff
  • Dedicated space for cohorting residents with COVID-19
  • Criteria for relaxing certain restrictions and mitigating the risk of resurgence
  • Visitation and service considerations
  • Restoration of survey activities

The guidance encourages state leaders to collaborate with the state survey agency and local health departments to decide how these criteria should be implemented.  Given the critical importance in limiting COVID-19 exposure in nursing homes, CMS recommends that decisions on relaxing restrictions be made with careful review of the following facility-level, community, and state factors:

  • Baseline test of all residents, weekly testing of all staff, practicing social distancing, and universal source control for residents and visitors (e.g., face coverings)
  • Status of COVID-19 cases in the local community
  • Status of COVID-19 cases in nursing homes
  • Adequate staffing
  • Access to adequate personal protective equipment (PPE)
  • Local hospital capacity

AHCA/NCAL’s detailed analysis is forthcoming.

Read the press release, guidance and FAQs from CMS.

Infection Prevention Control Officer (IPCO) Version 2 Training Now Available with BONUS COVID-19 Content

The emergence of COVID-19 has compounded the need for centers to have an effective infection prevention and control program. AHCA/NCAL’s new and expanded version of its popular Infection Preventionist Specialized Training, IPCO Version 2 is now available. The online training is recommended for individuals responsible for infection prevention and control in all long term care settings, including assisted living communities.

IPCO Version 2 is designed to train the Infection Preventionists to run a comprehensive infection prevention and control program. It is also now available for administrators to take to gain a deeper understanding of the infection prevention and control in the overall operation of a nursing facility. AHCA/NCAL recommends that each skilled nursing facility train at least two Infection Preventionists through AHCA/NCAL’s IPCO training program should one Infection Preventionist leave the facility. The training is also highly recommended for assisted living communities because they care for a similar population and can face similar infection risks.

As an added feature to all participants registered for the IPCO Version 2 program, bonus content related to COVID-19 is included. The bonus content includes topics such as: Interim COVID-19 Guidance, courses on PPE, and N-95 mask use.

Members will need to login with their AHCA/NCAL usernames and passwords to register for IPCO Version 2. For assistance obtaining AHCA/NCAL usernames and passwords, members should e-mail educate@ahca.org with their name and facility contact information.

OSHA Alert on Nursing Home and Long Term Care Workers’ Safety

The US Department of Labor’s Occupational Safety and Health Administration released guidance aimed at protecting nursing homes and long term care facilities workers from exposure to COVID-19. Many of the recommendations are based on CDC guidance including optimizing PPE, screening workers and sending sick workers home. The guidance includes encouraging staff to report any safety or health concerns and staggering breaks to avoid overcrowding in the break from.

Updated CARES Act Provider Relief Fund FAQs

The U.S. Department of Health and Human Services has posted a reorganized and updated set of Provider Relief Fund FAQs. Structurally, the document now is broken out by Allocation type: Targeted, General, Uninsured, Rural and Indian Health Services. FAQs of interest to AHCA/NCAL members that have received grants, specifically SNFs, include:

  • Additional detail on Attestation – DHHS provides information on accepting funds, rejecting funds, as well as how to accept one award but reject another.
  • Publication of Payment Data – Through a CDC data portal, DHHS now is displaying award data by provider name and award amount. Tax Identification Numbers (TIN) and provider type are not included in the database available here. DHHS notes in the FAQs is does not intend to add data elements such as NPIs, TINs, or other provider identification details.
  • Tranche 2 General Allocation Formula – DHHS show the formula and discusses why a provider that received a Tranche 1 allocation might not have received a Tranche 2 allocation.
  • Payment Portal – DHHS offers guidance on how providers without a TIN, such as county owned providers may attest and/or apply for funding.
  • Additional Payments – Additional detail is provided on requesting additional funds in the context of the 2% limit.

Economic Impact Payments for Social Security and SSI Beneficiaries with Representative Payees

The Social Security Administration recently issued an update that beneficiaries who have their regular monthly payments managed for them by another person, called a representative payee, will begin receiving their economic impact payments (EIPs) from the IRS in late May.

It is important to note that under Medicaid rules, a stimulus payment is not counted as income. Therefore, receiving a stimulus payment does not change a resident’s monthly payment (often called a ‘patient pay amount’ or ‘share of cost’). The resident pays the same monthly amount to the nursing facility and keeps the stimulus payment for their own use. In addition, the stimulus payment does not count as a Medicaid resource for 12 months. In other words, for the first year, the payment cannot cause you to have ‘too much’ savings.

More details on these payments can be found in this SSA press release. You may also find information about the eligibility requirements and other information about the Economic Impact Payments here. In addition, please continue to visit the IRS at  www.irs.gov/coronavirus for the latest information. Social Security will continue to update the agency’s COVID-19 web page with additional information.

H.R. 6800, The HEROES Act Passes the House

On Friday, May 15th, the United States House of Representatives passed H.R. 6800, The HEROES Act, another piece of legislation aimed at addressing the effects of the COVID-19 pandemic. This bill was passed largely along party lines with most Democrats voting for it and Republicans voting against the package. Leader McConnell has stated that he will not bring up this legislation in the Senate. The Senate is likely to craft its own bill. We will continue to work with both chambers and advocate for our priorities during this challenging time

Of particular note to our sector, below are the provisions found in the bill:

  • Ensures an additional $100 billion for the provider fund.
  • Improves the Accelerated and Advance Payment Program that has been critical to keeping providers afloat including lowering interest rates for repayment.
  • Allows facilities with the most losses from this pandemic to be compensated fairly.
  • Increases the Federal Matching Assistance Percentage (FMAP) by 14 percentage points through June 30, 2021. At a time of financial instability, this would ensure State governments have the resources they need to continue providing critical services.
  • Delays the implementation of the Medicaid Financial Accountability Rule (MFAR) until the end of the emergency period.
  • Requires Medicare’s Quality Improvement Organizations to provide infection control support to nursing homes struggling with COVID-19 outbreaks.
  • Ensures skilled nursing facilities have a means for residents to conduct “televisitation” with loved ones while in-person visits are not possible during the COVID-19 emergency.
  • Requires public reporting of positive cases in nursing facilities.
  • Provides $150 million to states to create strike teams if three or more residents or staff are diagnosed with COVID-19 in a 72-hour time period.
  • Provides a 20 percent per diem increase for facilities with COVID-19 only units.
  • Provides a $13.00 increase in wages for essential workers up to $10,000.

As the Senate begins to consider this bill, we will keep you updated as to what the final outcome will be.


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.

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 18th 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 15th by COB Monday, May 18th. 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 9th, 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

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).


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

Tips on how members of the public should wear cloth face coverings as directed by Executive Order

https://coronavirus.health.ny.gov/system/files/documents/2020/05/13105_covid-19_facemasks_flyer_050420.pdf


May 13th, 2020

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

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.

 

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

 

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

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 6th

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

Laboratory Reporting Requirements for SARS-CoV-2, Including all Molecular, Antigen, and Serological Tests (including “Rapid” Tests) and Ensuring Complete Reporting of Patient Demographics

As the landscape of available tests for the COVID-19 infection continues to evolve, it is essential that the reporting of results for SARS-CoV-2 testing is complete, accurate, and timely. Efforts to successfully reopen businesses, schools, and other entities affected by current social distancing requirements will rely upon State and local public health officials having greatly expanded access to testing and accurate testing data. These efforts will also rely upon promptly interviewing positive cases, performing contact investigations, and issuing isolation and quarantine orders.

05-01-2020 – NYSDOH – Clinical Laboratories, Limited Service Labs, and Other Entities Supporting SAR-CoV-2 Testin

CMS Issues Additional Blanket Regulatory Waivers

The Centers for Medicare and Medicaid Services (CMS) has issued several new blanket waivers for long term care providers. The following blanket waivers are in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration. We also offer a summary below.

CMS – New Blanket Waivers

•  Quality Assurance and Performance Improvement (QAPI) 

CMS is modifying certain QAPI program requirements—specifically, §483.75(b)–(d) and (e)(3)—to the extent necessary to narrow the scope of the QAPI program to focus on adverse events and infection control.

The following sections are waived:

  • §483.75(b) Program design and scope, which includes “address all systems of care and management practices”;
  • §483.75(c) Program feedback, data systems and monitoring;
  • §483.75(d) Program systematic analysis and systemic action; and
  • §483.75(e)(3) Performance improvement projects.

•  In-Service Training 

CMS is modifying the requirement that the nursing assistant must receive at least 12 hours of in-service training annually by postponing the deadline for completing this requirement until the end of the first full quarter after the declaration of the COVID-19 Public Health Emergency concludes.

•  Detailed Information Sharing for Discharge Planning for Long-Term Care (LTC) Facilities 

CMS is waiving the discharge planning requirement which requires LTC facilities to assist residents and their representatives in selecting a post-acute care provider using data, such as standardized patient assessment data, quality measures and resource use. CMS is maintaining all other discharge planning requirements, including the discharge plan.

•  Clinical Records 

CMS is modifying the requirement which requires LTC facilities to provide a resident a copy of their records within two working days (when requested by the resident) by allowing facilities ten working days to provide the requested record.

•  Inspection, Testing & Maintenance (ITM) under the Physical Environment

CMS is waiving certain physical environment requirements for providers including ICF/IIDs and SNFs/NFs to the extent necessary to permit facilities to adjust scheduled inspection, testing and maintenance (ITM) frequencies and activities for facility and medical equipment required by the Life Safety Code (LSC) and Health Care Facilities Code (HCFC.)

The following LSC and HCFC ITM are considered critical and are not included in this waiver:

  • Sprinkler system monthly electric motor-driven and weekly diesel engine-driven fire pump testing.
  • Portable fire extinguisher monthly inspection.
  • Elevators with firefighters’ emergency operations monthly testing.
  • Emergency generator 30 continuous minute monthly testing and associated transfer switch monthly testing.
  • Means of egress daily inspection in areas that have undergone construction, repair, alterations or additions to ensure its ability to be used instantly in case of emergency.

ICF/IIDs, and SNFs/NFs are required to have an outside window or outside door in every sleeping room. CMS will permit a waiver of these outside window and outside door requirements to permit these providers to use facility and non-facility space that is not normally used for patient care for temporary patient care or quarantine.

Note: Be aware that federal waivers such as these may not be applicable to state and/or local Authorities Having Jurisdiction (AHJs).

CMS Updates to Previously Issued Regulatory Blanket Waivers

CMS updated some language to blanket waivers that were previously issued at the end of March.

•  Resident Transfer and Discharge

CMS continues to waive requirements to allow a LTC facility to transfer or discharge residents to another LTC facility solely for the following cohorting purposes. Scenario two has added language regarding resident’s care plans in bold below.

  1. Transferring residents with symptoms of a respiratory infection or confirmed diagnosis of COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to the care of such residents;
  2. Transferring residents without symptoms of a respiratory infection or confirmed to not have COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to the care of such residents to prevent them from acquiring COVID-19, as well as providing treatment or therapy for other conditions as required by the resident’s plan of care; or
  3. Transferring residents without symptoms of a respiratory infection to another facility that agrees to accept each specific resident to observe for any signs or symptoms of a respiratory infection over 14 days.

•  Waive Pre-Admission Screening and Annual Resident Review (PASARR) 

CMS is allowing nursing homes to admit new residents who have not received Level 1 or Level 2 Preadmission Screening. Level 1 assessments may be performed post-admission. On or before the 30th day of admission, new patients admitted to nursing homes with a mental illness (MI) or intellectual disability (ID) should be referred promptly by the nursing home to State PASARR program for Level 2 Resident Review.

Note: This language is included in the summary waiver list for all providers and differs slightly from the text in the LTC specific waiver summary.

CMS Updates to Previously Issued ReimbursementBlanket Waivers

•  CMS Facility without Walls (Temporary Expansion Sites) – Transfer of COVID Patients

  • The transferring SNF need not issue a formal discharge in this situation, as it is still considered the provider and should bill Medicare normally for each day of care.
  • The transferring SNF is then responsible for reimbursing the other provider that accepted its resident(s) during the emergency period.
  • Processing Manual to submit a discharge bill to Medicare.
  • View a CMS QSO memo on transfers

•  Cost Report Delay

  • CMS will delay the filing deadline of FYE 10/31/2019 cost reports due by March 31, 2020 and FYE 11/30/2019 cost reports due by April 30, 2020. The extended cost report due dates for these October and November FYEs will be June 30, 2020.
  • CMS will also delay the filing deadline of the FYE 12/31/2019 cost reports due by May 31, 2020. The extended cost report due date for FYE 12/31/2019 will be July 31, 2020.

•  Telehealth

  • CMS is waiving the requirements of section 1834(m)(4)(E) of the Act and 42 CFR § 410.78 (b)(2) which specify the types of practitioners that may bill for their services when furnished as Medicare telehealth services from the distant site.
  • This waiver expands the types of health care professionals that can furnish distant site telehealth services to include all those that are eligible to bill Medicare for their professional services.
  • This allows health care professionals who were previously ineligible to furnish and bill for Medicare telehealth services, including physical therapists, occupational therapists, speech language pathologists, and others, to receive payment for Medicare telehealth services.
  • May impact SNFs that furnish outpatient therapy in AL, IL, and the community. CMS did not provide billing guidance – AHCA recommends SNF providers contact their MAC for guidance.

CMS Delays Implementation of New MDS Items (Transfer of Health Information and Certain SPADES) Adopted for the SNF QRP for 2 Years

The Interim final rule from CMS last night also delays implementation of new MDS items for SNF QRP as described below:

  • This delay will enable SNFs to continue using the current version of the MDS 3.0 v1.17.1
  • CMS will require SNFs to collect data on the transfer of health information measures and SPADES data on October 1 of the 1st of the year that is at least two full fiscal years after the end of the COVID-19 public health emergency.
  • CMS will work with SNFs prior to implementation to address questions related to training and software update needs.

Comments are due 60 days after the date of publication in the Federal Register.

Members should register for NHSN and review current processes in place for informing residents and families of COVID-19 infections or related symptoms.

CMS – The Medicare Promoting Interoperability Program Hardship Exception Application for Eligible Hospitals and Critical Access Hospitals is Now Available

The application for eligible hospitals and CAHs is available online via the QualityNet Secure Portal as a web-based application and can be found here. Previously registered users should already have account access, and new users can create an account by visitingQualityNet and selecting “Register”.

Medicare Promoting Interoperability Program Hardship Exception Application Details

  • You may now submit hardship applications electronically here.
  • If an electronic submission is not possible, you may verbally submit your application over the phone by calling the QualityNet Help Desk at (866) 288-8912.
  • The deadline for eligible hospitals to submit an application is September 1, 2020.Please note: This deadline has been extended from the original date of July 1, 2020 due to COVID-19.
  • The deadline for CAHs to submit an application is November 30, 2020.

CMS – New Frequently Asked Questions on EMTALA

CMS issued Frequently Asked Questions (FAQs) clarifying requirements and considerations for hospitals and other providers related to the Emergency Medical Treatment and Labor Act (EMTALA) during the COVID-19 pandemic. The FAQs address questions around patient presentation to the emergency department, EMTALA applicability across facility types, qualified medical professionals, medical screening exams, patient transfer and stabilization, telehealth, and other topics.

Frequently Asked Questions

CMS –  Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic

Building on its recent historic efforts to help the U.S. healthcare system manage the COVID-19 pandemic, CMS issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens. These changes include making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and continuing CMS’s efforts to further expand beneficiaries’ access to telehealth services. The temporary changes will apply immediately for the duration of the Public Health Emergency declaration.

Press Release

Additional Information


April 30th, 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

CMS Announces Independent Commission to Address Safety and Quality in Nursing Homes

Commission will comprehensively examine best practices in responding to COVID-19 in nursing homes

As a part of President Trump’s Opening Up America Again effort, the Centers for Medicare & Medicaid Services (CMS) announced a new independent Commission that will conduct a comprehensive assessment of the nursing home response to the 2019 Novel Coronavirus (COVID-19) pandemic. The Commission will provide independent recommendations to the contractor to review and report to CMS to help inform immediate and future responses to COVID-19 in nursing homes. This unprecedented effort builds upon the agency’s five-part planunveiled last April to ensure safety and quality in America’s nursing homes, as well as recent CMS efforts to combat the spread of COVID-19 within these facilities.  Tomorrow marks the beginning of Older Americans Month and, as we take this time to honor seniors, CMS remains committed to enacting policies that benefit our Nation’s seniors.

NYSDOH – Health Advisory: COVID-19 Serology Testing

Serological tests for determining the presence of antibodies against SARS-CoV-2 are now available from commercial manufacturers. Serology tests are used to determine if antibodies against SARS-CoV-2 are present. Certain serology tests can look for the general presence of SARS-CoV-2 antibodies, while others can determine if specific types of SARS-CoV-2 antibodies, such as IgM and/or IgG, are present.

04-30-2020 – NYSDOH – Serology Testing


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.

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

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

 

 

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:

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


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

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

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

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

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

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

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

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.

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

Today, under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) announced new regulatory requirements that will require nursing homes to inform residents, their families and 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. Finally, CMS will also require nursing homes to fully cooperate with CDC surveillance efforts around COVID-19 spread.
CDC will be providing a reporting tool to nursing homes that will support Federal efforts to collect nationwide data to assist in COVID-19 surveillance and response. This joint effort is a result of the CMS-CDC Work Group on Nursing Home Safety. CMS plans to make the data publicly available. This effort builds on recent recommendations from the American Health Care Association and Leading Age, two large nursing home industry associations, that nursing homes quickly report COVID-19 cases.
This data sharing project is only the most recent in the Trump Administration’s rapid and aggressive response to the COVID-19 pandemic. More details are available in the Press Release and Guidance Memo.

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

Today, the Centers for Medicare & Medicaid Services issues new recommendations specifically targeted to communities that are in Phase 1 of the Guidelines for President Trump’s Opening Up America Again with low incidence or relatively low and stable incidence of COVID-19 cases. The recommendations update earlier guidance provided by CMS on limiting non-essential surgeries and medical procedures. The new CMS guidelinesrecommend a gradual transition and encourage health care providers to coordinate with local and state public health officials, and to review the availability of personal protective equipment (PPE) and other supplies, workforce availability, facility readiness, and testing capacity when making the decision to re-start or increase in-person care.
The Guidelines for Opening Up America Again can be found here:https://www.whitehouse.gov/openingamerica/#criteria

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

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.

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.

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 16th 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).


April 13th, 2020

NYSDOH: COVID-19 Drug Topics

The Department of Health today issued COVID-19 Drug Topicswhich 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.

AHCA/NCAL – New OSHA Resources: Low/Unavailable PPE and Reporting Staff Cases

AHCA/NCAL released four new resources on guidance from the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control (CDC) on critically low or unavailable Personal Protective Equipment (PPE). These new resources are applicable to all long term care providers.

  • A form letter providers can fill in when responding to OSHA inquiries due to complaints regarding limited or unavailable PPE.
  • A document on OSHA guidance when PPE is critically low or unavailable including steps providers can follow.
  • An explanation of OSHA and CDC guidance on N95 respirators that are critically low or unavailable. This resource provides five options with guidance on what to do for a limited supply of N95 or other respirators to no N95 or other respirators available.
  • A document with updated guidance from OSHA on employer recording and reporting requirements for COVID-19.

CMS Revises COVID-19 FAQs on FFS Billing

CMS posted an updated version of their COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing document.  A change date is provided below each answer to indicate new and updated answers. The document is largely a repackaging of existing CMS guidance.

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

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

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.

OCME Procedure for Claiming Decedents at Nursing Homes

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.

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.

Experiencing staffing challenges in the midst of COVID-19?

IHA WIO IROQUOIS LOGOThese are challenging times, and we are in a war against an invisible enemy. The coronavirus is attacking New York’s healthcare delivery system, and long-term-care organizations across the state are on the front lines of this crisis.

In addition to shortages of supplies and equipment, as well as rapidly changing clinical guidance, organizations—like yours—are faced with growing concerns related to staffing and the future supply of an adequate workforce.

That is why IHA WIO is relaunching the Caring Gene® in our new Call to Care campaign, a multimedia effort to recruit individuals to both clinical and nonclinical roles within long-term-care organizations across the state.

The Call to Care campaign seeks individuals with an innate desire to care for others to join the fight in one of the most in-demand careers in the country. Preview the new campaign below.

In order to participate:

  • Complete our brief, online Participation Form.
  • We will periodically ask you to respond to surveys and provide IHA WIO with Google Analytics data in exchange for listing your long-term-care organization on www.caringgene.org. We ask that you provide us this data when requested so that we are able to make adjustments to the campaign to improve our ability to supply you with qualified job and training candidates. This data will also be shared with the New York State Department of Health.
  • You may wish to add the Caring Gene® to your organization’s job application as a means of tracking individuals through the campaign.

We encourage you to share our digital assets on your own social media pages, and to capitalize and leverage the Caring Gene® in your own recruitment efforts! Follow us on Facebook, Twitter, LinkedIn and YouTube and share our Caring Gene® content. Use the Caring Gene® in:

  • Internal & external newsletter articles
  • Staff & recruitment emails
  • Social media posts
  • Job fair collateral

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

CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week

The fact sheet on the accelerated/advance payment process and how to submit a request can be found here: Fact Sheet Providers can also contact their Medicare Administrative Contractor for any questions.


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:


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.


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.

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

COVID-19 NYSDOH

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.

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

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.

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.

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.

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.

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.

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

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

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 1st 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:

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.

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.


  • 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

NYSDOH – The release and guidelines of symptomatic and asymptomatic individuals in isolation

NYSDOH – Medicaid Changes to Private Duty Nursing (PDN) Policy

NYSDOH – Medicaid Changes to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Policy

The New York State Department of Health (NYSDOH) is providing this guidance to Medicaid Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) providers pertaining to the current novel coronavirus (COVID-19) outbreak. As a result, and to expedite and simplify the enrollment process, the Department of Health’s Bureau of Provider Enrollment has taken action to implement the following …

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

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

NYSDOH – Health Homes Serving Children, C-YES, HCBS Providers, and MMCP/HIV SNP regarding 1915(c) HCBS Children’s Waiver:


March 28th, 2020

AHCA/NCAL – Medicare Accelerated and Advanced Payments Now Available

CMS announced today (March 28) that it is expanding its accelerated and advance payment program for Medicare providers. These payments provide emergency funding and address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. In this situation, CMS is expanding the program for all Medicare providers throughout the country during the public health emergency related to COVID-19.

To qualify for accelerated or advance payments, the provider or supplier must:

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

Medicare will start accepting and processing the Accelerated and Advance Payment Requests immediately. CMS anticipates that the payments will be issued within 7 days of the provider’s request. See an informational fact sheeton the accelerated/advance payment process and how to submit a request.CMS guidance on provider eligibility and submission processes from today’s announcement differ from those found in the Medicare Financial Management Manual, Overpayments, Chapter 8, Section 150. Providers should contact their MACs, directly, to understand how the MAC will be operationalizing CMS’s guidance. CMS is delegating the payment request processing to the MACs. See the MAC regional coverage map.

AHCA/NCAL – Telehealth Toolkit

CMS recently issued an electronic toolkit regarding telehealth and telemedicine for Long Term Care Nursing Home Facilities. CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility.

This document contains electronic links to reliable sources of information regarding telehealth and telemedicine, including the significant changes made by CMS in response to the National Health Emergency.  Most of the information is directed towards providers who may want to establish a permanent telemedicine program, but there is information here that will help in the temporary deployment of a telemedicine program as well.

There are specific documents identified that will be useful in choosing telemedicine vendors, equipment, and software, initiating a telemedicine program, monitoring patients remotely, and developing documentation tools. There is also information that will be useful for providers who intend to care for patients through electronic virtual services that may be temporarily used during the COVID-19 pandemic.


March 27th, 2020

Attached please find a Medicaid Update Special Edition, issued on March 27 by the New York State Department of Health, featuring an updated New York State Medicaid Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID-19).  This guidance is an amended version of the original, sent March 10, 2020.

This Medicaid Update Special Edition will available on the Medicaid Update webpage.

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

NYSDOH – Infection Control Guidance for  Supportive Housing Programs

This guidance is applicable to the following Department of Health Supportive Housing Programs:

  • • DOH Empire State Supportive Housing Initiative (ESSHI) Projects
  • • Health Home Supportive Housing Program
  • • Olmstead Supportive Housing Program
  • • Rapid Transition Housing Program

NYSDOH SPECIAL EDITION: NYS Medicaid Coverage and Reimbursement Policy for Services Related to COVID-19

Reimbursement_SpecialEdition_MedicaidUpdate_03-27-2020


March 26th, 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

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


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

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 GuidanceAttached 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.

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.

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


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.

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

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

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

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

Guidance Regarding ACF Operations During COVID-19 Outbreak

In response to inquiries received to date, the Department provides the following 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.

Medicaid Update — Special Edition

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

COVID-19 Guidance to Transportation Managers and Brokers

COVID-19 Guidance for SNF Seeking Emergency Approval

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


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

NYSDOH – Guidance on the Contacts of a Close or Proximate Contact of a Confirmed or Suspected Case 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.

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

CDC – PPEs Guidance »

 

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

3-Day Stay and Spell of Illness Waivers: NYSHFA | NYSCAL has been working with AHCA to secure greater clarity on the Section 1812(f) 3-Day Stay and Spell of Illness Waivers. AHCA is working on a more detailed set of FAQs with improved case examples that we anticipate will be finalized tomorrow.

Child Care: NYSHFA | NYSCAL is continuing to discuss the need for additional child care resources in light of numerous school closings throughout the State. We are awaiting details regarding the plans submitted to Governor Cuomo pursuant to his directive that all counties submit child care plans to the State by midnight March 16th. Additionally, we are awaiting additional guidance on the NYC DOE Educational Guidance (see attached) providing for the establishment of “Regional Enrichment Centers” and early childhood centers in NYC to accommodate children of essential service providers, including health care workers.

ADHC Suspensions (Social & Medical): Attached, please find two separate directives from the Department of Health imposing an immediate temporary suspension of all Statewide Adult Day Health Care programs.

Hospital COVID-19 Testing Prior to Resident Admission: NYSHFA/NYSCAL has raised with both the Governor’s office and the DOH the need for hospitals to test patients for COVID-19, especially those presenting any symptoms of COVID-19, prior to discharging such patients to a facility.

Temporary Resident Stays with Families: NYSHFA/NYSCAL is discussing the issue of providers identifying residents that may be able to go with home to their family temporarily and then return to the facility following the COVID-19 pandemic while reimbursement continued to be provided to the facility in the absence of bed hold (beyond the State’s current therapeutic leave policy).

10% Expansion of Capacity: NYSHFA/NYSCAL has raised the issue of expanding facility capacity by 10% if a facility has sufficient room to do so in an effort to alleviate pressures on hospitals (this was done during Superstorm Sandy).

New Sick Leave/Quarantine Requirements: The Governor and the Legislature have reached agreement on new sick leave legislation that would require, among other things: 1) employers with between 11 and 99 employees as of 1/1/20 to provide at least 5 days of paid sick leave to each employee who is subject to a mandatory or precautionary order of quarantine or isolation; and 2) require employers of 100 or more employees as of 1/1/20 to provide at least 14 days of paid sick leave to each employee who is subject to a mandatory or precautionary order of quarantine or isolation.


March 16th, 2020

NYSDOH – Additional Medicaid Pharmacy Guidance Regarding the Declared Disaster Emergency in the State of New York over COVID-19

The following guidance would only be effective until the official Declared Disaster Emergency in the State of New York over COVID-19 has ended.

NYSDOH – Health Advisory: Protocols for Personnel to Return to Work Following COVID-19 Exposure

Healthcare facilities may allow healthcare personnel (HCP) exposed to or recovering from Covid-19, whether direct care providers or other facility staff, to work under the following conditions:


March 15th, 2020

EMERGENCY FACT SHEET & BLANKET WAIVERS

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

CMS – Blanket Waivers of Federal Laws:

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


March 14th, 2020

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

Skilled Nursing Facility Visitation Guidance

Health Advisory: COVID-19 Cases in Nursing Homes and Adult Care Facilities

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.


What Else We Are Doing …

  • NYSHFA/NYSCAL is in direct communication with the Governor’s office and the DOH as we speak to amend the guidance protocols and further educate them on the dangerously low supplies of face masks and the need to constrain the use of face masks to best protect our residents and employees
  • NYSHFA/NYSCAL is working with the Governor’s office and the DOH to restrain the State’s guidance to the current CMS guidelines that recommend a 6-foot radius face mask requirement. The CMS guidelines call for the utilization of a face mask when within a 6-foot radius for the following circumstances:
    • Staff treating COVID-19 infected patients;
    • Staff interviewing and assessing patients demonstrating symptoms of COVID-19; and
    • Staff interviewing and assessing individuals without symptoms who have been exposed to a lab-confirmed case of COVID-19.
  • NYSHFA/NYSCAL is discussing with the Governor’s office and the DOH the significant financial implications providers are facing as a consequence of the COVID-19 pandemic and the need for reimbursement assistance.

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.


March 12th, 2020

URGENT NEED BY COB TODAY – 02-12-2020:

NYSHFA | NYSCAL and AHCA have been asked by the U.S. Department of Health and Human Services (HHS) to conduct a representative survey of nursing homes and assisted living providers in New York to understand and help highlight the magnitude of the shortage of Personal Protective Equipment (PPE) to the administration and other health officials.

We know members are anxious about supplies. It is CRITICALLY IMPORTANT the data collected in this survey is accurate in order to help make quick decisions about the supply shortage. The survey will take 5-10 minutes of your time.

– DUE TO IT’S IMPORTANCE & PRIVACY – THIS SURVEY HAS BEEN EMAILED DIRECTLY FROM NYSHFA | NYSCAL.

  • Check your inbox and SPAM folders. Should you have any questions or did not receive it, please contact us at info@nyshfa-nyscal.org

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 – 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.


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 …
DO-NOT-VISIT_POSTER

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

Health Advisory: Criteria for Discontinuation of Isolation of Patients with COVID-19


March 7th, 2020

Nursing Home Guidance for Novel Coronavirus (COVID-19)

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.

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.


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.

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.


Since COVID-19 is spread from person-to-person through droplets in the air, very similar to how influenza spreads, centers should use the strategies known to reduce the spread of respiratory viruses which includes:

  • Monitor your staff and visitors for following hand washing or use of alcohol hand gels
  • Review your contact isolation procedures and make sure staff follow them consistently
  • Review plans for cohorting residents in the same room or wing who become sick to prevent the spread to other residents and staff, should the outbreak continue to grow
  • Remind staff, contractors, volunteers to stay home if they are sick (see detailed guidance here)
  • Starting now, post notices for visitors who are sick to stop visiting and work with families on alternate ways to visit their family members, like Skype, phone calls and email. Check with the local health department if they are recommending more restrictive criteria for visitations as COVID-19 spreads.
  • Stay in close contact with your local and state health department
    • Make sure your infection preventionist signs up for health department announcements as well as CDC announcements
  • Monitor the CDC COVID-19 website for the latest information on Coronavirus prevention strategies, testing guidance and recommendations for health care workers. Centers need to review testing guidelines for testing of persons under investigation suspected of COVID-19.
  • Make sure your staff are aware and keep up with CDC and your local health department guidelines (which are changing) as to when to contact them for testing suspected cases. You should provide information to your staff and their families on what they can do to protect themselves. Per CDC this includes:
  • Following preventive actions known to prevent the spread of viruses including:
    • Washing your hands, using alcohol-based hand sanitizers,
    • Covering your cough
    • Staying home when you are sick (which includes any of the following: fever, cough, runny nose, sore throat)
  • The CDC does NOT currently recommend the general public to use facemasks.

We have communicated to CDC and CMS that long term care providers are having trouble accessing types of personal protective equipment such as masks, gowns, etc. due to the worldwide shortage related to decreases in exports from select countries, including China, India, and Taiwan, and increases in demand.

The CDC has offered strategies for health care providers on how to optimize supplies of N95 respirators in the face of decreasing supply, which can be found here. These strategies include

  • Minimizing the number of health care professionals who need to use respiratory protection
  • Use alternatives to N95 respirators, such as facemasks where feasible, and prioritize the use of N95 respirators for those with the highest risk of acquiring infection or experiencing complications from infection

You can learn more about the CDC’s strategies for optimizing the supply of personal protective equipment here.

If a health care provider, including long term care providers, is experiencing challenges meeting personal protective equipment needs, please contact your state and local health departments.


NYSDOH 2019-nCoV Public Hotline

Attached Guidance: 




Cyber Terrorism Alert:

As a result of recent events involving the US and Iran, and the threat of retaliation (potentially cyber-based) by Iran, the NYSDOH is asking all health care providers to take additional steps in protecting information systems and critical infrastructure.

Please take the following measures to avoid phishing attempts, exposure of data from systems and the possible interruption of patient/resident services, such as:

  • Screen emails for unknown senders
  • Avoid use of personal email or social media at workstations
  • Use caution in following email links and opening attachments by authenticating the sender
  • Monitor the function of medical devices throughout the facility and take immediate action if any suspicious performance is recognized

Additionally, the announcement sent by the Health and Human Services, Assistant Secretary for Preparedness and Response (ASPR), Critical Infrastructure Division and from the Acting Secretary of the Department of Homeland Security pertaining to the terror threat to the U.S. homeland is the following:


There are many things you can do to prepare for an emergency that may be the result of a natural disaster or act of terrorism.  The Northeast is subject to year-round conditions which could pose a threat and create a disaster situation.  A severe storm, flood, fire, windstorm, utility failure, hazardous materials spill, or act of terrorism may require the implementation of an emergency preparedness plan.

NYSHFA | NYSCAL will continue to keep you informed before, during and after a regional or statewide emergency or disaster.  Please visit this site regularly to stay up-to-date on the most current information available.

Notices:

Agencies/Contact Information:
  • New York Emergency Alert
  • New York State Department of Health – Aware/Prepare Emergency Preparedness Homepage
    Information and resources for families, individuals, caregivers, and health care providers.
  • New York State Department of Health – Aware/Prepare Resources for Health Care Providers
    Emergency preparedness fact sheets, tools and resources especially for health care providers.
  • New York State Department of Health
      • Division of Hospitals and Diagnostic & Treatment Centers
        (including Community Health Centers)
        :
        CAPITAL REGION
        Program Director: 518-408-5329
        CENTRAL REGION
        Program Director: 315-477-8592
        METROPOLITAN REGION
        Program Director: 212-417-5990
        WESTERN REGION
        Program Director: (Buffalo) 716-847-4357  (Rochester)585-423-8141
        CENTRAL OFFICE
        Division Director: 518-402-1004

     

      • Division of Nursing Homes and ICF / IID Surveillance:
        CAPITAL REGION
        Program Director: 518-408-4372 (or) 518-408-5433
        CENTRAL REGION
        Program Director: 315-477-8417
        METROPOLITAN REGION
        Program Director: 212-417-6197
        WESTERN REGION
        Program Director: (Buffalo) 716-847-4348 , (Rochester) 585-423-8019
        CENTRAL OFFICE
        Division Director: 518-408-1267

     

      • Adult Care Facility and Assisted Living Surveillance Program:
        CAPITAL REGION
        Program Director: 518-408-5287
        CENTRAL REGION
        Program Director: 315-477-8472
        METROPOLITAN REGION
        Program Director: 212-417-5814
        WESTERN REGION
        Program Director: (Rochester) 585-423-8185
        CENTRAL OFFICE
        Division Director: 518-408-1133

     

      • Division of Home and Community Based Services:
        CAPITAL REGION
        Program Director: 518-408-1128
        CENTRAL REGION
        Program Director: 315-477-8422
        METROPOLITAN REGION
        Program Director: 212-417-4970
        WESTERN REGION
        Program Director: (Buffalo) 716-847-4655 , (Rochester) 585-423-8142
        CENTRAL OFFICE
        Division Director: 518-473-9871

     

    • Regional Survey Offices
      CAPITAL DISTRICT
      Kim Valenti: 518-408-5433
      CENTRAL NEW YORK
      Nancy Finnigan: 315-477-8417
      WESTERN NY – BUFFALO
      Joe Egnaczak: 716-847-4348
      WESTERN NY – ROCHESTER
      Joe Egnaczak: 585-423-8020
      MARO – NYC – PD
      Leah Ryer: 212-417-4900; Shawn Dudley: 212-417-4900 ; Kanu Basak: 212-417-4900 ; Clement Ogbonna: 212-417-4900
      MARO – LONG ISLAND
      Leah Ryer: 631-851-3610
      MARO – NEW ROCHELLE
      Leah Ryer: 914-654-7058

Workplace Violence

Violence in the workplace can range from a bomb threat to being physically attacked by a fellow employee or patient to being verbally abused or harassed by a boss or coworker. The following resources provide information on how to deal with violence in your workplace.

Resources

Active Shooter

If an armed gunman enters your facility and started shooting, you have no time to learn how to deal with the situation. The resources listed below will help you plan and prepare so you will know what to do if an active shooter enters your facility.

Resources

Cyber Alert

The New York State Department of Health (NYSDOH) and the NYS Department of Homeland Security are sharing the guidance regarding a serious and destructive malware infection known as “Ryuk,” and its associated precursor infections. Please share this with your information technology staff and consultants, so that they can immediately take appropriate action to protect your information resources.

Resources

Natural Disasters & Severe Weather

Fires, earthquakes, floods, hurricanes, tornadoes and extreme heat and cold can all wreak havoc on the physical structure of your facility and the safety of residents and patients. These resources can help you cope and keep those under your care safe and secure.

Resources