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04/08/2020

Today's COVID-19 Report: Wednesday, April 8, 2020

Wednesday, April 8, 2020

Here are the latest need-to-know updates for Wednesday, April 8 regarding the COVID-19 pandemic.

All-member Call - Tomorrow, Thursday, April 9, 10:30 a.m.

LeadingAge Ohio is holding an all-member COVID-19 update call tomorrow, Thursday, April 9 at 10:30 a.m. On the call, LeadingAge Ohio members will hear from Director of Aging Ursel McElroy on how Ohio is preparing to serve Ohioans in their communities, and LeadingAge Ohio staff will share crucial updates on the development of COVID-19 “isolation centers” in Ohio nursing homes, as well as the expansion of Medicaid telehealth rules to include home health and hospice.

Call in registration is as follows:

For best call quality, we encourage using your computer audio. This also allows callers to easily send questions to the speakers via the 'chat' function. Questions can also be sent to the COVID19@leadingageohio.org email address.

For best call quality, we encourage using your computer audio.

Dial in information:

Or iPhone one-tap :

US: +13126266799,,650714845#

Or Telephone:

US: +1 312 626 6799 

Webinar ID: 650 714 845

New Q&A on Nursing Home Aide Training

This week’s hottest topic for questions from members is the waiver granted by CMS last week, which waived nurse aide training and certification requirements.

The waiver reads:

Training and Certification of Nurse Aids: CMS is waiving the requirements at 42 CFR §483.35(d), (except for 42 CFR §483.35(d)(1)(i)), which require that a SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements under §483.35(d). CMS is waiving these requirements to assist in potential staffing shortages seen with the COVID-19 pandemic. To ensure the health and safety of nursing home residents, CMS is not waiving §483.35(d)(1)(i), which requires facilities to not use any individual working as a nurse aide for more than four months, on a full-time basis, unless that individual is competent to provide nursing and nursing related services. We further note that we are not waiving §483.35(c), which requires facilities to ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care. Achieving adequate staffing levels may be a concern for SNFs and NFs during the public health emergency. CMS is temporarily waiving these requirements so they do not present barriers for SNFs and NFs to hire staff; the temporary waiver will help these facilities provide adequate levels of staffing for the duration of the COVID-19 pandemic.

Last week, the Ohio Department of Health (ODH) confirmed that unless the blanket waiver specifies Medicare, waivers are interpreted to apply to both the Medicare and Medicaid program. At this time, the waiver has only been granted for nurse aides practicing in nursing homes, and does not include home health or hospice aides.

LeadingAge Ohio has organized a Q&A document summarizing our most-asked nurse aide questions. These questions have been reviewed/approved by the Ohio Department of Health, and will be incorporated into the larger LeadingAge Ohio COVID-19 Q&A document later this week. 

ODH: Providers May Not Bill for Federally Supplied PPE, Pharmaceuticals

In a bulletin sent to providers via the EIDC system this morning, ODH clarified that "under federal guidance, healthcare facilities may be able to charge patients a fee for administering medical countermeasures (such as for healthcare provider time), but they cannot charge patients for any federally supplied medical assets or pharmaceuticals."

The bulletin went on to note that this includes any PPE, supplies, equipment and pharmaceuticals provided by the federal government. Providers may be able to bill for certain services, like dispensing or administration fees.

CMS Clarifies Hospice Telehealth 

On its “office hours” call yesterday, staff experts from the Centers for Medicare & Medicaid Services (CMS) fielded a variety of provider questions related to the COVID-19 pandemic. One topic they addressed was related to telehealth visits of hospice patients.

CMS confirmed that routine home care visits could be done using audio-only (telephone) technology, and also confirmed that the initial assessment could be performed this way. When pressed, they offered further clarity:

“To the extent that telehealth can offer a full assessment of the patient/caregiver needs in a way that enables you to develop an accurate care plan and deliver services…it can be used."

In response to a question about whether telehealth visits could be counted as visits in the last days of life for the service intensity add-on (SIA) payment, CMS noted that its “current thinking” is that telehealth would meet the requirements for routine home care visits, but would not “rise to the level of being an add-on.”

HUD Updates Providers

Last night, the Department of Housing and Urban Development (HUD) released a recorded update on COVID-19 issues. LeadingAge VP of Housing Policy Linda Couch wrote an article to summarize key aspects of the update. 

One of the most significant statements was that HUD is looking to waive its usual procedures for getting funding disbursed as it figures out how to move the new service coordinator funding out to housing providers. The direct quote is as follows:

“The funding to replace tenant incomes will be triggered by tenant recertifications and should be a fairly quick and invisible process. For the portion of funding going to Service Coordinators, this is slightly more complicated because these dollars usually would come with a NOFA and a longer process. We’re working through the procedures to see what we can waive and what we can do to get that funding out to properties as quickly as we can.”

Pandemic Unemployment Assistance 

LeadingAge has provided updated information regarding unemployment benefits under the recently passed CARES Act. Under normal circumstances, if an employee quits work, they are ineligible for unemployment insurance. The CARES Act, however, creates a funding stream, referred to as Pandemic Unemployment Assistance (PUA), for persons ineligible under regular unemployment insurance.  

One category of individuals that qualify for the benefits are those that “had to quit their job as a direct result of COVID-19.” There was concern that some employees will quit in a general fear of contracting COVID-19 and would qualify under this provision, which has obvious workforce implications. Second, with the added $600 per week, some employees could make more per week with this benefit than by working. On April 5, the Department of Labor (USDOL) put out guidance on the PUA.

The following excerpt is from page I-6 of the full document that seems to directly address these concerns:

The individual has to quit his or her job as a direct result of COVID-19.  For example: 

  • An individual was diagnosed with COVID-19 by a qualified medical professional, and although the individual no longer has COVID-19, the illness caused health complications that render the individual objectively unable to perform his or her essential job functions, with or without a reasonable accommodation.

Guidance for Discontinuing Transmission-Based Precautions in COVID-19 Patients

Provider associations worked alongside the Ohio Department of Health (ODH) this past weekend to develop the fact sheet “Guidance for Discontinuing Transmission-Based Precautions in COVID-19 Patients". The fact sheet reflects the importance of understanding each and every individuals’ unique care needs, even as it provides a standardization of approach. 

This fact sheet is accompanied by an extensive process mapping protocol that, once finalized, should help to guide the decision-making for care of individuals across the continuum – those with and without a positive COVID-19 diagnosis, from those residing in their homes to those who are hospitalized. These protocols are still undergoing review and further refinement and ultimate decision-making will reflect both the unique nature of the state’s eight regions as well as an individual’s unique care needs. 

More will follow in the next few days as ODM/ODA/ODH finalize the protocols across all settings.

REMINDER: New ODH Daily Survey Covers Vents, PPE, Staffing

The weekly ventilator survey requested by the Administration last week has been expanded and altered significantly, as reported in yesterday's COVID-19 report. 

Providers should check their inbox today for an expanded daily survey that will provide the Administration as much information as possible related to aging services (full continuum) providers’ needs related to staffing, PPE, and testing. Completing the survey the first time should require 10 – 15 minutes of time, as facility/entity information and data points (contact info, number of beds, census, etc.) need to be input. 

After the first submission, the survey should take less than 5 minutes each day. The Administration is asking that the survey be completed as consistently as possible on a day-to-day basis, i.e. that a small number of staff take responsibility each day for completing the survey. 

All providers are encouraged to complete the survey in order for the Administration to understand the PPE and other needs of our aging services providers.

Stimulus Bill Tools

Two tools have been created to help long-term care providers understand what help is available to them through the two Federal COVID-19 Bills that have been signed into law as of April 1 - the Families First COVID Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (CARES).

One is specific to providers that bill Medicare Part A (COVID-19 Stimulus Bill Facility Impact Calculator with Part A). There are certain advance payments and sequestration suspensions that apply to these providers. The other calculator just looks at the SBA loan and forgiveness program (COVID 19 Stimulus Bill Facility Impact Calculator). We have also attached a description document. 

Guidance, Updates and Information from Partners and Associate Firms

A number of COVID-19 member resources have been developed by LeadingAge Ohio Partner and Associate firms. These resources cover a range of topics, from “deep-dives” into the Paycheck Protection Act to Virtual Tour opportunities. The “LeadingAge Ohio Partner and Associate Firm Guidance and Updates” page is linked on the COVID-19 Hub for easy access. Link-age, Ziegler and Value First have provided content, among other partners. This page is updated regularly as additional resources arrive.

Healthcare Leaders’ COVID-19 Virtual Symposium

On Thursday, April 9, at 1:00 p.m., LeadingAge Ohio associate firm HealthPRO Heritage, in collaboration with CliftonLarsonAllen, Ziegler, MatrixCare and others, has pulled together what promises to be a rich discussion between several thought-leaders to share perspective and best practices developed thus far in the response efforts to COVID-19.

Registration is available online or you can visit the “LeadingAge Ohio Partner and Associate Firm Guidance and Updates” page.

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.

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Our national partner, LeadingAge, is an association of 6,000 not-for-profit organizations dedicated to expanding the world of possibilities for aging. Together, we advance policies, promote practices and conduct research that support, enable and empower people to live fully as they age.