05/06/2020

Today's COVID-19 Report: Wednesday, May 6, 2020

Wednesday, May 6, 2020

Here are the latest need-to-know updates for Wednesday, May 6 regarding the COVID-19 pandemic.

Dispatch Column - Help Us Spread the Word

The LeadingAge Ohio member-led Post-Acute Regional Rapid Testing (PARRT) initiative was featured in a column by our President/CEO Kathryn Brod in the Columbus Dispatch today. It is an informative read that we hope will assist policymakers and the public in understanding the needs of those who serve our most vulnerable population. 

Please take a moment to read the column, and consider sharing it on Twitter or Facebook. Tag your state legislators!

Hospice Coalition to Meet with Palmetto in June

The Hospice Coalition will be meeting with Palmetto representatives on a virtual platform in June. 

Questions for Palmetto may be sent to Jeff Lycan at jlycan@NHCooperative.org by May 15. Palmetto has also published the latest Hospice Coalition Q&A for providers as well as Palmetto’s fourth quarter 2019 Hospice Appeals Report. 

Questions regarding the Palmetto Q&A or Hospice Appeals Report may be sent to Anne Shelley at ashelley@leadingageohio.org.

ODH to Host Long-term Care Webinar

The Ohio Department of Health (ODH) Bureau of Infectious Diseases is hosting a webinar on Friday about prevention and control of COVID-19 in long-term care settings. In this webinar, attendees will hear from fellow nursing facilities, representatives of ODH, and Centers for Disease Control and Prevention (CDC) on strategies to prevent and limit the spread of COVID-19.

Topics will include:

•       Welcome by ODH Director Dr. Amy Acton;
•       Communication;
•       Early and aggressive intervention when identifying suspected cases;
•       Cohorting residents and staff;
•       Personal protective equipment: appropriate use and reuse; and
•       Hand and environmental hygiene.

The webinar will be held on Friday, May 8 at 2:00 p.m.

Webinar Connection: http://progressive.powerstream.net/008/00153/CovidLTC.mp4 

NAHC Clarifies Emergency Funding, Addresses Claw-back Concerns

Many LeadingAge Ohio members have asked about the plans for the second round of distribution of emergency funding, and whether some providers may be at risk of having funds disbursed during the first round taken back by the Centers for Medicare and Medicaid Services (CMS). William A. Dombi, President of the National Association for Home Care & Hospice (NAHC), distributed the following message to providers related to questions on the Emergency Fund Distribution. 

The message is as follows:

Recently, a number of questions have been raised about the interplay between the Emergency Fund distribution that occurred on April 10 and 17 with the second distribution that began on April 24. Specifically, the question was whether there would be a “take-back” of monies when the amount distributed in the first round was greater than the calculated amount set out in the second distribution. The first distribution was based on a provider’s 2019 Fee for Service Medicare claims data. Providers received approximately 6.2% of that amount with an intended total of $30 billion across the whole Medicare program.

The second distribution is based on 2% of the providers “net patient revenue” for 2018. Cost reports and other documentation is being used for that distribution. The Department of Health and Human Services issued a calculation formula based on $2.5 Trillion in overall spending with a fund payment of 2% of that amount for purposes of distributing both the initial $30B and an additional $20B.  Since that formula combined the two distributions, the question surfaced as to whether some providers would need to give money back if the first distribution exceeded the amount calculated through the second formula. NAHC data shows that nearly 85% of HHAs and virtually all hospices would potentially be in a take-back position as the proportion of fee for services revenues exceeded 32.25% of the total revenues, the point when the first distribution calculation would be greater than the second distribution calculation. 

After more than a week of confusion and anxiety, NAHC had the opportunity to raise the issue today with HHS Deputy Secretary Eric Hargan and his team. Hargan confirmed that HHS does not intend to take back any of the funds from the first distribution based on the calculation determined under the second formula. Instead, any take-back would be limited to a later reconciliation based on a provider’s use of the money. The fund is available to help offset the costs of dealing with Covid-19 and any resulting loss of revenues.

In our conversation, an example was presented of an HHA with $20 million in overall net patient revenue and $10 million in Medicare fee for service revenue. With the first distribution, that HHA would have  received approximately $620,000.  With the second formula to distribute the additional $20 billion, the overall distribution would be calculated at $400,000. That means the HHA would not receive any distribution from the second round as it was less than was already issued to the provider. Hargan confirmed that the HHA would not need to return the  $220,000 difference. The full $620,000 would be subject though to a later determination as to whether the funds were fully used on Covid-19 costs and lost revenue. 

Providers are required to file quarterly reports on such. NAHC’s HHFMA Workgroup has developed a documentation template for securing that data. A webinar presenting the template took place last Thursday, with Part 2 scheduled for 2:30 PM on Thursday, May 7. 

Hargan further indicated that the “overpayment “ reference in the attestation portal for the fund is meant to address situations where the provider knows that the fund distribution calculation is in error. For example, if the amount tendered does not conform to the provider’s 2019 fee for service claim revenue or the overall net patient revenue from 2018.  It is intended to address errors in those data inputs.

HHS will be issuing an FAQ to clarify the standard applied to the first and second distributions very soon. If they are unable to finalize the FAQ in time to have providers submit an attestation by the 30 day deadline, HHS will extend the deadline.

Benesch COVID-19 Resource: Just in Time for Return to Work

LeadingAge Ohio partner Benesch summarized new guidance related to employees’ health and safety as they return to work. 

The Equal Employment Opportunity Commission (EEOC) has provided new guidance addressing returning workers with Pre-Existing Medical Conditions.The 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). 

Yesterday, the EEOC provided new guidance addressing how employers could mitigate or eliminate direct threats to a returning employee’s own health and safety. Benesch provided a Q&A, which also includes analysis of prior EEOC guidance in the same format.

The abaqis COVID-19 Self-Assessment, Courtesy of Medline and HealthStream 

LeadingAge Ohio partner Medline has offered a free resource through one of their partners, HealthStream. The abaqis COVID-19 Self-Assessment exactly replicates the COVID-19 Focused Survey for Nursing Homes from CMS, including relevant guidance from CMS and the CDC. With ODH announcing this week that they will begin onsite infection control surveys, this tool, with links to the relevant CMS and CDC webpages, would assist providers in re-evaluating their current compliance with the standards. The tool could be completed and put into the QAPI committee meeting minutes to confirm self-evaluation with the Infection Control standards of practice.

This assessment can currently be accessed at no charge, courtesy of Medline and HealthStream.

Combating Social Isolation for Seniors During the COVID-19 Pandemic

Tomorrow, Thursday, May 7 is National Older Adults Mental Health Awareness Day. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) is holding a webinar tomorrow, May 7 from 1:00 - 2:30 p.m., to discuss practical ideas to promote connection and recovery for older adults with serious mental illness and substance use disorders.

DeWine Announces State Budget Cuts

Governor DeWine yesterday announced $775 million in reductions to Ohio's General Revenue Fund for the remainder of Fiscal Year 2020 which ends on June 30. 

At the end of February and prior to the onset of the COVID-19 pandemic, state revenues for the fiscal year were ahead of estimates by over $200 million. As of the end of April, Ohio's revenues were below the budgeted estimates by $776.9 million.

Because Ohio is mandated to balance its budget each year, in addition to identifying areas of savings, the following budget reductions will be made for the next two months:

• Medicaid:  $210 million
• K12 Foundation Payment Reduction:  $300 million
• Other Education Budget Line Items:  $55 million
• Higher Education:  $110 million
• All Other Agencies:  $100 million

"Decisions like these are extremely difficult, but they are decisions that are part of my responsibility, as your governor, to make," said Governor DeWine.  “We believe that instituting these cuts now will provide the most stability moving forward, however I am greatly concerned about the cuts we must make in education. We have an obligation to our schools to give them as much predictability as we can, but if we don’t make these cuts now, future cuts would be more dramatic." 

The budget reductions are in addition to Governor DeWine's March 23 directive to freeze hiring, new contracts, pay increases, and promotions at all state agencies, boards, and commissions. The new budget reductions will not apply to critical services available to Ohioans or COVID-19 pandemic services. Money to balance the Fiscal Year 2020 budget will not be drawn from Ohio's Budget Stabilization Fund, otherwise known as the "rainy-day fund."

Projections by Ohio Office of Budget and Management (OBM) Director Kim Murnieks indicate that the state’s revenues will continue to be below estimates in the coming months as Ohio moves through the COVID-19 crisis. LeadingAge Ohio continues to advocate for the needs of its members amid these competing priorities. 

ODM Needs Provider Contacts

In a continuing effort to collect as many current email addresses as possible prior to emailing the FYs 2017 & 2018 overpayment reports, the Ohio Department of Medicaid (ODM) has asked if members would send two valid email addresses to LTCAudits@medicaid.ohio.gov. This should include the Ohio Medicaid seven-digit number in the subject line.

If only one email address is possible, that will suffice. However, ODM prefers to be able to include a second person on the email to ensure the reports are delivered. ODM will add this information to its current list to ensure as many facility’s as possible are able to participate in this streamlined approach.  

Based on current events, ODM does not have an established date to begin sending these reports.

ODM has updated its letters and response forms for providers which are listed below .  

• Independent Living and IID Sample Letter and Response Form Update
• Nursing Facility Sample Letter and Response Form Update

To highlight the significant updates to these forms, ODM noted it has:

• Added language to account for the reports being emailed;
• Clarified language regarding providers’ not being required to send supporting documentation along with the response form if requesting a resolution;
• Added areas to collect additional email addresses;
• Removed mailing address so that LTCAudits@medicaid.ohio.gov is the only address to send forms/supporting documentation/agreements/etc;
• Clarified language regarding the true nature of requesting a reconsideration.

LeadingAge Requests More Support in Next Stimulus

LeadingAge sent requests for the next stimulus bill to Congress yesterday. There are a number of new measures under discussion and in various stages of development.

The LeadingAge requests include: 

• A $100 billion allocation specifically for aging and disability service providers to cover additional costs for PPE, cleaning supplies, staffing, and other needs associated with coronavirus.
• A $1.2 billion housing package to provide for rent and staffing supports, Service Coordinators, WiFi capability, and other assistance for the more than 1.1 million older adults served by federally-assisted housing.
• A funding source that specifically provides “hazard pay” for frontline workers.
• Priority access to PPE and testing, without which residents, clients, and staff continue to be at significant and avoidable risk.
• Uniform reporting of COVID cases and deaths in a way that enables information to be reported once and used for many purposes including public transparency and tracking needs.
• Funding that enables our members to expand their capabilities by becoming extended or step-down entities and clarification that a COVID-19 diagnosis is a skilled need under Medicare.
• Additional funding and some loosening of restrictions on the loan programs that have been set up to support providers as they fight coronavirus and struggle to survive beyond the crisis.
• Compensation for home health telehealth visits and increased access to telehealth and technology across aging settings.
• Grants to support Medicaid HCBS providers and PACE programs, to strengthen care and services in the home for vulnerable older persons and persons with disabilities.
• A 12% FMAP increase.  Enhance the Medicaid federal matching share from the initial increase of 6.2 percentage points to 12 percentage points.
• That Congress charter and fund a post-COVID Bipartisan Congressional Commission to develop a legislative strategy that establishes a planful infrastructure of aging services that is adequately financed, promotes quality of care and quality of life, and enables all Americans to grow old with dignity.

LeadingAge will share more details on the stimulus package as this legislation develops. 

Provider Relief Fund Updates

LeadingAge learned through National Association of State Medicaid Directors (NAMD) that state Medicaid agencies were asked on May 1 to submit data to the U.S. Department of Health & Human Services (HHS) by yesterday, May 5. NAMD indicated some states may need extensions to compile the requested data and get it to HHS. LeadingAge believes this will be the information HHS uses to determine the payments to Medicaid-only providers.  

LeadingAge continues to report that HHS does not intend take back any of the funds from the first distribution from providers at this point. There has been concern particularly for home health and hospice providers based off the initial formulas being used to calculate the first and second distribution of funds with 85% of home health and the majority of hospice providers being at risk of losing a portion of the first distribution. HHS has confirmed home health and hospice providers would only need to return funds if after reconciled, providers' expenses and lost revenues related to COVID-19 did not exceed the payments received. See the detailed NAHC example above. 

HHS is working on written guidance to this effect, and will inform members as more information is available on this topic.

Paycheck Protection Program Updates

The Department of Treasury/Small Business Administration (SBA) issued yesterday a new question in its FAQs, extending the deadline for borrowers’ safe harbor repayment one week, from May 7 to May 14. 

This gives SBA time to provide additional guidance on how it will review certification.  In addition, it gives providers a little more time to work out a solution to the problems that have arisen related to SBA loans to affordable housing providers. Treasury/SBA also issued data on PPP Round 2 loans.

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.