05/07/2020

Today's COVID-19 Report: Thursday, May 7, 2020

Thursday, May 7, 2020

Here are the latest need-to-know updates for Thursday, May 7 regarding the COVID-19 pandemic.

Medicaid Waiver Reporting Required

On April 15 Director Acton issued an order issued an order requiring nursing home, residential care facility, and independent living settings to notify residents, residents’ sponsors and/or guardians of a positive or probable COVID-19 case within the setting. Assisted living waiver providers are required to also notify the PAA and/or MyCare plan of a positive or probable COVID-19 case within the setting.

Notification to the PAA and/or MyCare plan is only required upon the first COVID-19 positive or probable case in the setting. This does not change the requirement that a setting notify a waiver case manager or waiver service coordinator if the setting becomes aware a waiver enrollee is COVID-19 positive or probable. 

CMS Releases New QSO-20-29-NH Memo

The Centers for Medicare & Medicaid Services (CMS) released the new QSO-20-29-NH memo Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes on May 6. The memo provides details on the guidance on the NHSN reporting requirement, updates to the survey forms, new deficiency tags, enforcement for noncompliance, and publicly reporting of the NHSN data.

CMS has updated the “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” to include an updated assessment of the new requirements for facilities to report to the NHSN and to residents, their representatives, and their families. The updated documents can be found in the downloads sections of the CMS Nursing Home regulatory webpage.

Nursing Homes are encouraged to begin using the revised “COVID-19 Focused new deficiency tags for citing noncompliance with the new requirements." These new regulatory requirements are:

• F884: COVID-19 Reporting to CDC as required at §483.80(g)(1)-(2) Review for F884 will be conducted offsite by CMS Federal surveyors (state surveyors should not cite this F-tag). Following an initial reporting grace period granted to facilities, CMS will receive the CDC NHSN COVID-19 reported data and review for timely and complete reporting of all data elements. Facilities identified as not reporting will receive a deficiency citation at F884 on the CMS-2567 with a scope and severity level at an F (no actual harm with a potential for more than minimal harm that is not an Immediate Jeopardy [IJ] and that is widespread; this is a systemic failure with the potential to affect a large portion or all of the residents or employees), and be subject to an enforcement remedy.
• F885: COVID-19 Reporting to Residents, their Representatives, and Families as required at §483.80(g)(3)(i)-(iii) Review for F885 is included in the “COVID-19 Focused Survey Protocol” and will occur onsite by State and/or Federal surveyors. If the survey finds noncompliance with this requirement, a deficiency citation at this tag will be recorded on the CMS-2567 and enforcement actions will follow the memo QSO-20-20-All. We note that there are a variety of ways that facilities can meet this requirement, such as informing families and representatives through email listservs, website postings, paper notification, and/or recorded telephone messages. We do not expect facilities to make individual telephone calls to each resident’s family or responsible party to inform them that a resident in the facility has laboratory-confirmed COVID-19. However, we expect facilities to take reasonable efforts to make it easy for residents, their representatives, and families to obtain the information facilities are required to provide. In addition, when the State Survey Agency is planning to conduct these surveys, the COVID-19 Focused Survey should be coded in the Automated Survey Process Environment (ASPEN) under “Survey Type” as U=COVID-19. If the survey is taking place with an IJ complaint.

The CMS enforcement timeline is as follows:

• May 8 – Effective date of the rule
• May 17– Initial reporting of data due
• May 24 – Grace period to report ends
• May 31 – Warning letter to report
• June 7 – CMP fine of $1,000 fine will be imposed
• June 14 – CMS will impose additional weekly fines at subsequent increases of $500 equaling $1500 (total of $2500)
• June 21 – CMS increase the fine by another $500 equaling $2,000 (total now at $4,500)

CMS will publicly report the CDC’s NHSN data (including facility names, number of COVID-19 suspected and confirmed cases, deaths, and other data as determined appropriate) weekly on https://data.cms.gov/ by the end of May. The CMS memo includes a Q&A relevant to the reporting requirement.

CMS updated the COVID-19 Focused Survey for Nursing Homes survey tool with two new critical elements:

• F885 Identify the mechanism(s) the facility is using to inform residents, their representatives, and families (e.g., newsletter, email, website, recorded voice message). Did the facility inform all residents, their representatives, and families by 5 PM the next calendar day following the occurrence of a single confirmed COVID-19 infection or of three or more residents or staff with new onset of respiratory symptoms that occurred within 72 hours of each other? Did the information include mitigating actions taken by the facility to prevent or reduce the risk of transmission, including if normal operations in the nursing home will be altered (e.g., restrictions to visitation or group activities)? Did the information include personally identifiable information? Is the facility providing cumulative updates to residents, their representatives, and families at least weekly or by 5 PM the next calendar day following the subsequent occurrence of either: each time a confirmed COVID-19 infection is identified, or whenever three or more residents or staff with new onset of respiratory symptoms occur within 72 hours of each other? Interview a resident and a resident representative or family member to determine whether they are receiving timely notifications.
• F884 Reporting to the Centers for Disease Control and Prevention (CDC) – Performed Offsite by CMS. For consideration by CMS Federal Surveyors only. Review CDC data files provided to CMS to determine if the facility is reporting at least once a week. Review data files to determine if all data elements required in the National Healthcare Safety Network (NHSN) COVID-19 Module are completed.

If you have questions on the new QSO-20-29-NH memo, please reach out to Stephanie DeWees at sdewees@leadingageohio.org. 

Retraction: EEOC Article on Health, Safety

An article which summarized new guidance related to employees’ health and safety as they return to work was included in yesterday's report. The Equal Employment Opportunity Commission (EEOC) has retracted section G.4 of the information that was shared. 

EEOC has been providing employers with ongoing guidance on addressing COVID-19 related issues in the workplace, including advice on how employers could legally assess and eliminate direct threats to the health and safety of their workforce while complying with the Americans with Disabilities Act (ADA). On May 5, the EEOC updated its guidance on accommodating employees with underlying medical conditions and subsequently retracted part of this guidance (see G.4).

The EEOC’s guidance, including the retraction, can be found here. 

Statements on Reopening…Or Not

The American Health Care Association's (AHCA) Provider Magazine featured an article yesterday on the impact on aging services when states reopen their economies. 

Included is a quote from LeadingAge's President/CEO Katie Smith Sloan, which read:

“At the outset of this pandemic it was clear that older adults were at the greatest risk. LeadingAge members have dedicated their lives to keeping them safe and healthy--in nursing homes, assisted living, and other care settings. As states consider reopening, it’s critical that the places where the most vulnerable people live, like nursing homes, move slowly and deliberately in easing restrictions. They must have ample PPE and testing to reopen in a way that protects both residents and staff.”   

The article includes a statement from the American Medical Directors Association (AMDA) saying that decisions to reopen or relax social distancing requirements in long-term care communities is a case by case decision and should be approached with caution. LeadingAge Ohio is in active discussions with the Ohio Medical Directors Association (OMDA) and other provider associations on the impact the opening of the economy may have on long-term care communities. There is consensus on the need for ongoing vigilance in visitor restriction.

LeadingAge CEO to Meet with HHS Deputy Secretary on Friday

Katie Smith Sloan, President and CEO of LeadingAge, will be meeting with U.S. Department of Health and Human Services (HHS) Deputy Secretary Eric Hargan on Friday. 

Among other things, Sloan will discuss aging services providers’ desperate need for testing and PPE, as well as staffing shortages; and ask Secretary Hargan for relief on these challenges. Sloan will describe what the providers, their staff, and the people they serve are experiencing, as well as ask questions about the Provider Relief Fund and express concerns about the double (or triple) reporting now required of nursing homes.

COVID-19 Illness and Minority Groups

LeadingAge is monitoring the impacts of the virus on racial and ethnic minorities.

A recent Centers for Disease Control and Prevention (CDC) report showed substantially higher death rates among minority groups; HUD Secretary Carson has been tasked with leading a White House effort to support underserved communities through the crisis.

LeadingAge provided an analysis on the situation here.  

Recovery Tools for Affordable Housing Operations

As some housing providers pivot from crisis-management to recovery, the U.S. Department of Housing and Urban Development (HUD) has encouraged the use of capacity building tools to safely shift operations.

The toolkit offers several key worksheets for use by housing providers moving into the recovery phase.

Activity Professionals: Mark Your Calendar to Participate in May 14 Call

Last week, activity professionals within the LeadingAge Ohio membership came together through Zoom to offer support, share ideas, and discuss resources in the midst of current COVID-19 restrictions. 

We want to continue to grow this community and we need your help!  This group is planning to meet bi-weekly through a Zoom platform hosted by Kendal at Oberlin Director of Creative Arts Therapy/Dementia Specialist Michele Tarsitano-Amato. The next call is scheduled for Thursday, May 14, at 12:30 PM.

Zoom Fellowship Meeting for Activity Professionals
Thursday, May 14 from 12:30 PM – 1:15 PM
Host: CreativeArtsKendal@gmail.com is inviting you to a scheduled Zoom meeting. 
Join the Zoom Meeting online.
Meeting ID: 979 1175 8968

The focus next week will be on care planning; members can send sample care plans for SNF, RCF/AL and independent living around Risk for Social Isolation due to COVID19 to Jen Taylor at jtaylor@leadingageohio.org ahead of the call. Jen is compiling a member protected resource page for our activity professionals. The group will also discuss this year’s LeadingAge Ohio Art & Writing program to find a way to celebrate the gifts and talents of residents during this pandemic.   

Provider Dashboard Updated, Check for Accuracy

Yesterday, the Ohio Department of Health (ODH) refreshed the long-term care COVID-19 case dashboard.  Members should check their numbers for accuracy, and report any inaccuracies to their local health department. 

Please contact Susan Wallace at swallace@leadingageohio.org if you require assistance. 

Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook group to pose questions to peers and share best practices.