COVID-19 Resources for Members and Non-members

Resources are listed by date they were posted.

LeadingAge Daily Call: Register for the LeadingAge Daily call-in update. You only need to register one time to be added to daily reminders. The calls are 5 days a week @ 3:30 ET (2:30 CT). Register here: https://attendee.gotowebinar.com/register/1365743381042881035.

NEBRASKA ICAP CALL FOR LONG-TERM CARE, Every Thursday at noon CT: Join Dr. Salman Ashraf and the team at Nebraska ICAP for the weekly call for long-term care providers. Join from a PC, Mac, iPad, iPhone or Android device. Please click this URL to join: https://unmc.zoom.us/j/183449940 Or join by phone: Dial(for higher quality, dial a number based on your current location): US: +1 346 248 7799 or +1 669 900 6833 or +1 253 215 8782 or +1 301 715 8592 or +1 312 626 6799 or +1 646 876 9923 Webinar ID: 183 449 940 International numbers available: https://unmc.zoom.us/u/abwmjKOfYp

Link and Calendar Information for Monthly Calls with DHHS (Connie Vogt): As was shared last week, the weekly calls that were being held on Wednesdays with DHHS, Connie Vogt and others, are now monthly calls. Details are included below. LeadingAge Nebraska, in partnership with NHCA, will hold these member connections via Zoom. Volumes of information have been disseminated related to COVID-19, including the waivers issued by CMS and the Governor. Temporary processes have been put in place related to COVID-19 reporting and working with the DHHS Survey and Epi teams. Join this call to get guidance on these issues, hear about the current processes, and ask your questions.
- Monthly Connection with Connie Vogt, Second Wednesday of the Month @ 10:00 a.m. CT. Begins August 12th.
  - Aug 12, 2020
  - Sep 9, 2020
  - Oct 14, 2020
  - Nov 11, 2020
  - Dec 9, 2020
  - Jan 13, 2021
  - Feb 10, 2021
- Join: https://nehca-org.zoom.us/j/96222516275 | Or call: 669-900-9128 | Webinar ID: 962 2251 6275
- To download and import the calls to your calendar: https://nehca-org.zoom.us/webinar/tJIvdeutrz0oHdFY9OynC4JQ5kI8wekywIGt/ics?icsToken=98tyKuCurDkoH9WTsh6CRowAAIjoa-_zmCFBgqd7pUbKGi5wNinHY-lraqV6G8HH

WEEKLY CALL WITH NEBRASKA DHHS REPRESENTATIVES, CONNIE VOGT, DAN TAYLOR, AND DAWN SYBRANT: These calls begin @ 10:00 CT and will recur every Wednesday.
- Join via Zoom: https://zoom.us/j/96222516275 Or call: 669-900-9128 REMINDER: don't use this phone number, use the phone number on the screen. Webinar ID: 962 2251 6275

Testing Calls Beginning Monday, June 15: Beginning Monday, June 15, there will be a daily presentation of the details for the new state wide Long-Term Care Facility Baseline Testing Project. The call will be from 4:00-5:00 CT. To join the Webex calls click HERE. Meeting access code: 145 603 4492 Meeting password: Qk5DvSdYM68 If you would like to schedule an individual call after attending one of the information sessions please contact Z Winfrey at zidarta.winfrey@nebraska.gov.

*Some links may only be available to LeadingAge national provider members.

11/23/20: Update on Per Diem Increase Processing for NF/AL: Jeremy Brunssen with the DHHS Division of Medicaid and Long-Term Care provided an update last Friday regarding the $20 per day temporary payment rate increases to NF and AL providers. As was shared a few weeks ago, NF payments have all been updated and the retroactive claims ran just over a week ago. Providers should have received those payments last Wednesday. Special needs days did not process, so those should have processed this past weekend and be received by this Wednesday (11/25).

On the ALF side - all the of rates have been updated and retroactive claims were run this past weekend. Payments for ALFs should be received Wednesday of this week. MLTC received approval last Friday from CMS on the Appendix K for the ALF temporary rate increase.

The MLTC NF team is updating rate sheets for the Jan-June 2021 rate period and should have all the rate sheets sent to providers by December 11th. This will have minor changes from the current (July-December) Rate sheets. The only changes would be related to a quality measure score/Rate add on changed, and a fixed cost increases that were requested/approved.

On Friday, Nebraska Medicaid updated their Provider Bulletin to clarify that the temporary per diem increase also applies to the Nursing Facility per diem rate paid for Hospice Services furnished by Hospice providers in Nursing Facilities.

11/23/20: NHSN Changes *REGISTER* Updates to the COVID-19 reporting module on NHSN went live today. NHSN will hold office hours TOMORROW, Tuesday, November 24 at 11am ET (10am CT) to review these changes. Register here.

11/23/20: Strategies for Optimizing the Supply of N95 Respirators: Today CDC updated guidance on how to optimize N95 respirators during COVID-19, adding crisis capacity strategies, including a recommendation to limit the number of reuses to no more than five donnings per device if no manufacturer guidance is available.

11/23/20: HUD Reopens COVID-19 Payment Applications: Today, HUD announced the continued availability of supplemental funds for HUD-assisted multifamily housing providers responding to COVID-19. In July, HUD had announced the initial request period for COVID-19 Supplemental Payments; the new HUD notice establishes a second request window and updates the submission requirements. The filing deadline for multifamily housing owners is December 11, 2020 for expenses incurred through November 30. Properties that did not receive payments for the earlier timeframe (March 27-July 31) may resubmit for that period as well. Compared to the previous notice, HUD has made changes to include clarifications on the eligibility of RAD Section 8 properties, eligible activities for CSP funds, and allowable signatories for the request form. More information will be available here on Tuesday.

11/23/20: Nursing Home Infection Control Incentive Payments: Provider Quality Incentive Payments (QIP) were determined using data collected by the Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN) (https://www.cdc.gov/nhsn/ltc/covid19/index.html). To be eligible for September payments, facilities were required to properly report 10 weeks of NHSN data: the 4 weeks of the September performance period and the 6 preceding weeks. Facilities that believe they were eligible for a September payment, but did not receive a payment, should work directly with NHSN to ensure that their data is accurately represented and data reporting issues do not occur going forward. This requirement is listed under "NHSN data quality checks" that are performed for each nursing home and stated in the methodology document (top of p. 2). Please make sure that your reporting meets the requirements described above.

Today, HHS informed LeadingAge that the second portion of the September payment (an additional $80+M) will begin going on out on Monday, Nov. 30 to 8,925 nursing homes (no list available) based off of the nursing home's mortality performance. The smallest payment is $101.22 and the highest payment will be more than $1.1M. LeadingAge national has updated the article related to these payments. The September mortality portion of the payment was delayed as HHS tried to collect additional mortality data from nursing homes beyond what is reported on NHSN. HHS has concluded that going forward they will use total fatalities for the performance period instead of trying to discern between deaths of residents due to COVID admissions vs. in-facility infections. The updated Nursing Home Infection Control incentive payment methodology can be reviewed here.

HHS indicated it will soon publish the facility-level detail about the September payments on the Provider Relief Fund website that LeadingAge has been asking for. This should help those organizations with multiple nursing homes know how to distribute the funds.

Providers who receive an incentive payment have 90 days to attest to the payment using the attestation portal and must use these funds for Infection Control expenses as specified under the Terms & Conditions for the NHIC Distribution. Providers must attest every time they receive a Provider Relief Fund payment. Providers can opt to reject these payments as well.

11/23/20: Monoclonal Antibody Treatment - LTC Pilot: As you have likely heard, Nebraska is part of a pilot study for LTC related to Bamlanivimab. As doses start shipping out to currently identified pilot participants, here is a SUMMARY of the Emergency Use Authorization shared with the permission of Andrew Watkins, Pharm.D. with the UNMC ASAP Team. As indicated in the summary, the drug can be left at room temperature for 7 hours. Those 7 hours include the one hour time for administration, meaning administration would need to start by hour 6.

11/23/20: Beneficiary Care Management Program (BCMP): CMS has a new program, BCMP. One of their initiatives includes supporting Medicare Fee-for-Service beneficiaries undergoing a discharge appeal and experiencing chronic medical conditions requiring lifelong care management. The ultimate goal is to reduce high-cost healthcare utilization such as hospital readmissions and emergency room visits. Information for providers and beneficiaries is available at https://www.bcmpqio.org.

11/23/20: CMS Calls Certain Nursing Homes: LeadingAge has heard from CMS about phone calls they are making to nursing homes in red or yellow counties who report no testing in the NHSN. The calls are legitimate. As CMS looks at NHSN data and monitoring if facilities report if they are testing when they also report cases. Individuals from our Office Program Operations and Local Engagement (OPOLE) and QIOs will be calling nursing homes to ask them why they may be in a yellow or red county, yet reported no staff testing. Or, if they reported cases, yet reported no outbreak testing. The calls are not being done from a survey perspective. So, if you get a call from CMS regarding testing, you'll know what is triggering the call.

11/23/20: Temporary Nurse Aide Training: Many of you had been using the free-of-cost EduCare program that was available through the LeadingAge Learning Hub to train your Temp Nurse Aides. The training IS STILL AVAILABLE, but no longer in the Learning Hub. Here is the link to the new location on the EduCare site.

11/23/20: DHHS Approves Guidance Documents Today:

Guidance on Outings and Home Visits: *Repost from 11/18: Over the past few weeks we have discussed guidance related to Outings and Home Visits in particularly in conjunction with the upcoming holidays. CDC has provided guidance related to the holidays as well. DHHS approved guidance related to Nebraska today.

Guidance on Nasal Swabbing: On member calls we have discussed the need for clarification on who can do nasal swabbing for the various types of tests being used currently in LTC. Today DHHS approved guidance related to Nasal Swabbing as well. Many of you have indicated that due to staff resources it would be helpful to have non-nurses help with this process.

DHHS Approved Guidance on Nasal Swabbing

11/23/20: LeadingAge Testing Toolkit NOW AVAILABLE to Members *Repost from 11/18: LeadingAge National in conjunction with Pathway Health are developing a series of COVID-19 toolkits for members. The first in the series is a Testing Toolkit and it is AVAILABLE now exclusively to LeadingAge members. The document has to be considered in relation to State guidance, of course, but contains some terrific resources, such as an Antigen Testing Policy, Billing for COVID-19 Testing, Competency Checklist and Training Plan. LA provider members, you will need your email and password (for national) to access the Toolkit through your my.leadingage.org account. If you are a LeadingAge Nebraska provider member, you are also a LeadingAge national member.

To create a My LeadingAge account and get access to all the Member Benefits go to https://my.leadingage.org/core/user/login.aspx. If you need assistance with your My LeadingAge account call 1-888-508-9441 or email MyLeadingAgeSupport@LeadingAge.org.

LeadingAge Testing Toolkit

11/18/20: UPDATE FROM EARLIER TODAY: CMS has now released an ALERT for the holidays.

Key points from the CMS alert include:

CMS will not be relaxing visitation restrictions for the holidays.
Providers should educate residents/families on the risks of going out (and discourage leaving).
If the resident/family insists on leaving, providers should educate them on mitigation strategies.
Providers may need to consider additional precautions upon return for those who choose to leave.
Providers should also discourage staff from attending gatherings and engaging in other risky behavior.

Don't forget these helpful resources from CDC:

Return to Work Criteria for Healthcare Personnel

11/18/20: DHHS Approves Guidance Documents Today: Guidance on Outings and Home Visits: Over the past few weeks we have discussed guidance related to Outings and Home Visits in particularly in conjunction with the upcoming holidays. CDC has provided guidance related to the holidays as well. DHHS approved guidance related to Nebraska today.

11/18/20: Guidance on Nasal Swabbing: On member calls we have discussed the need for clarification on who can do nasal swabbing for the various types of tests being used currently in LTC. Today DHHS approved guidance related to Nasal Swabbing as well. Many of you have indicated that due to staff resources it would be helpful to have non-nurses help with this process.

DHHS Approved Guidance on Nasal Swabbing

11/18/20: LeadingAge Testing Toolkit NOW AVAILABLE to Members: LeadingAge National in conjunction with Pathway Health are developing a series of COVID-19 toolkits for members. The first in the series is a Testing Toolkit and it is AVAILABLE now exclusively to LeadingAge members. The document has to be considered in relation to State guidance, of course, but contains some terrific resources, such as an Antigen Testing Policy, Billing for COVID-19 Testing, Competency Checklist and Training Plan. LA provider members, you will need your email and password (for national) to access the Toolkit through your my.leadingage.org account. If you are a LeadingAge Nebraska provider member, you are also a LeadingAge national member.

To create a My LeadingAge account and get access to all the Member Benefits go to https://my.leadingage.org/core/user/login.aspx. If you need assistance with your My LeadingAge account call 1-888-508-9441 or email MyLeadingAgeSupport@LeadingAge.org.

LeadingAge Testing Toolkit

11/18/20: Changes Coming to NHSN: As providers continue to report to NHSN, more changes are on the way. NHSN will be making some changes to Testing, Confirmed Tests, Reinfection, COVID-19 Deaths, and Non-COVID Related Respiratory Infection. Also, a reminder that ALL tests run must be reported to satisfy the CLIA requirements. That can be done in NHSN.

11/18/20: Nursing Home Compare Retired: In September, CMS unveiled a consolidated "Care Compare" site that merged the 8 provider-specific sites into one. Since then, consumers have been able to access Nursing Home Compare, Hospice Compare, Home Health Compare, etc. all under the same location of https://www.medicare.gov/care-compare/. CMS announced today that the provider-specific sites have officially been retired. The information that is displayed on Care Compare has not changed from what was displayed on the previous compare sites, but has been consolidated under one interface with an updated look.

11/18/20: NHSN Nursing Home Occupancy by State: Nationwide, the nursing home occupancy rate is 71%, with a range from 57% - 83%. Here's a run of NHSN data on occupancy rates by state as of October 25.

11/16/20: 2020 LeadingAge Award of Honor: Watch the video below to see Katie Smith-Sloan congratulating this year's Award of Honor recipients: EVERY MEMBER OF LeadingAge.

Every year, we bestow this award on one member who has provided nationally significant, transformative leadership in aging services. This person shows vision, mission, compassion, and courage every day in their communities.

This year, in the face of great adversity and overwhelming tragedy, you have all risen to the occasion and demonstrated remarkable leadership and unbelievable courage in what will likely be remembered as the hardest year of your life.

Thank you for all you've done and that you continue to do. I am proud and honored to call you friends and colleagues.

--Katie Smith Sloan, president and CEO of LeadingAge

LeadingAge Nebraska members, you can save the image below to share on your website, with an email, or on social media. Thank you from the depths of our hearts for the amazing and hard work that you do every day. #courageous

11/16/20: Holiday Visitation Guidance: As the holidays near and circumstances around the state continue to change we know that there are many questions on how to best handle get togethers (or not). Along those lines, there is a guidance document pending with DHHS on the state level that will provide some additional framework. The word on the street is that CMS will be putting something out "soon". We have been hearing that for the past few weeks. What we have also heard is that the CMS information will be relatively broad. We know that CDC has put out a fair amount of information related to holiday gatherings that you can see in this LeadingAge article- CDC and State on Thanksgiving: Travel and Gathering. LeadingAge national also worked on surveying members to see how folks will approach holiday gatherings and visits. In the following article- You Asked, You Answered: Thanksgiving Planning Survey Results, LeadingAge provides an overview of the information from the survey.

11/16/20: Monoclonal Antibody Pilot Project for LTC: As we spoke during last Wednesday's member call, there is a plan to start rolling out an infusion treatment available to COVID positive, non-hospitalized, symptomatic NF and ALF residents. You may have already heard from your local or regional hospital provider about this and it is anticipated to start soon with Great Plains Health in North Platte. In order to prioritize which LTC providers may be able to come into the pilot next, LTC providers will likely be receiving a survey in the next day or two from DHHS requesting more information.

11/16/20: Suicide Prevention Training Opportunity for LTC *Still time to register*: LeadingAge Nebraska has been contacted by the University of Nebraska Public Policy Center to participate in a training program that they have funding for related to prevention of suicide in LTC. The Partners in Preparedness group through the College of Public Health will also be included in this opportunity.

This effort begins with training one individual in up to 50 LTCF locations to become a trainer in the evidence-based life-saving practice of Question, Persuade, and Refer (QPR) ©. Just as people trained in CPR help save thousands of lives each year, people trained in QPR learn how to recognize the warning signs of suicide and crisis, and how to properly question, persuade, and refer someone to help. Trained staff within your facility will be equipped with the skills and materials to train 25+ fellow coworkers in QPR. This is being offered at NO COST to the initial 50 providers and includes the materials and licensing for those participants. If you are a multi-site location you have the option to train a designee from each location or one for all locations. If you are interested in this opportunity, here is the link to register: https://go.unl.edu/FrontlineQPR. Click HERE for more details on the training opportunity.

Contact Natalie McCormick at natalie.mccormick@leadingagene.org if you have questions!

Senior Housing Weekly: Recap of LeadingAge Updates (11/13/20)
Nursing Home Weekly: Recap of LeadingAge Update (11/13/20)

11/11/20: New DHMs Take Effect Today in Nebraska: Today, new DHMs were implemented in Nebraska. You can view a summary of the updated DHMs HERE.

11/11/20: Member Call Today: If you were able to join the member call today you heard about work being done in a number of areas regarding the surge in positive cases around the state, the need for hospital beds, and the possibility of a pilot launching with LTC providers related to monoclonal antibodies. There will be more to follow on all of these issues. Information will be rolling out quickly. If you have any innovative approaches to collaboration with your local hospital, please share it with Jenifer (jenifer.acierno@leadingagene.org). We heard from many of you that you would be willing to take "step-down" level patients from hospitals but for staffing and survey. We hear you. In regard to staffing, please see this DOCUMENT spreadsheet provided by FEMA to Angela Ling at DHHS. It includes a long list of potential workforce options.

Also included from today's member call is this sample Positive Resident Treatment Plan that was shared by an attendee.

11/11/20: Additional NHSN Training- POC Reporting: CDC has announced 2 more training session opportunities on the new point-of-care testing tool on NHSN. Trainings will be held this week on Thursday, November 12 at 3:00pm ET and Friday, November 13 at 12:00pm ET. Register for these training sessions here. The slides have been posted here. CDC has indicated that a recording of the training session will be posted in the future.

11/11/20: Provider Relief Funds- Missing Payments? A quick update for those of you who did not receive an Infection Control Incentive Payment but believe that you met the gateway criteria. HHS has NOT published a list of nursing homes who received the incentive payments or how much they are. LeadingAge national continues to pursue these issues with HHS. If you are a nursing home in this situation and you HAVE NOT yet discussed with Jenifer, you may submit your information to Nicole Fallon at LeadingAge national using this survey monkey tool: https://www.surveymonkey.com/r/M7K9625. If you have already discussed with Jenifer your information has already been included.

Providers who are stuck in PRF Phase 2 due to TIN validation or no payment received can also submit their information to Nicole using this survey monkey link: https://www.surveymonkey.com/r/MLRHT9D.

11/11/20: Holiday Plans Survey For Residential Providers: As the holidays approach, we know that many members are working hard to figure out the best way to plan for celebrations, travel, and family gatherings for residents and staff. LeadingAge national wants to get a better sense of where members are landing on plans, so they have developed a short survey on residential providers' plans for accommodating residents, staff and families who want to gather together with loved ones over the holidays. If your organization provides affordable housing, assisted living, independent living, life plan/CCRC, memory support home or nursing home care, please take this 5-question survey. The deadline is Thursday, Nov 12. Thank you!

This issue remains a hot topic. LeadingAge released an article that reviews Member Solutions for a COVID-Safe Thanksgiving earlier in the week and now has released this companion article on CDC and States Guidance for Thanksgiving: Travel and Gatherings. More Nebraska state level information to follow soon.

11/11/20: Suicide Prevention Training Opportunity for LTC - *Still time to register* LeadingAge Nebraska has been contacted by the University of Nebraska Public Policy Center to participate in a training program that they have funding for related to prevention of suicide in LTC. The Partners in Preparedness group through the College of Public Health will also be included in this opportunity.

If you are interested in this opportunity, here is the link to register: https://go.unl.edu/FrontlineQPR. Click HERE for more details on the training opportunity. Contact Natalie McCormick at natalie.mccormick@leadingagene.org if you have questions!

11/9/20: LeadingAge Introduces the Pandemic Playbook: This year will be remembered as a time when the worst pandemic in a century brought isolation, illness, and death to too many older adults and the people who care for them across settings in communities around the country. LeadingAge believes this year has also brought tremendous lessons for aging services providers. That's why we're proud to develop the Pandemic Playbook, an interactive collection of insight, wisdom, and best practices for serving older adults during a catastrophic health crisis like the one we're facing now.

LeadingAge members have learned critical lessons about navigating a pandemic. We've gathered your collective intelligence for the future. The Pandemic Playbook will help ensure that aging services providers-in our membership and beyond-can prepare for and mitigate the impact of a pandemic by applying learning from this year.

Visit the Playbook now at playbook.leadingage.org. Please feel free to share the Playbook with your colleagues, LeadingAge members or not.

Our field has learned so much about dealing with the pandemic. Why not benefit from lessons learned by 700+ LeadingAge members? Some highlights of the Pandemic Playbook:

Need to communicate with your staff, residents, the media, etc.? Use our communications templates for clear messaging and time-saving advantages.
Struggling with how to safely re-open to visitors? We have an entire Chapter on Reopening.
Have workforce issues? See how LTSS providers have maintained staffing levels and rewarded staff dedication.
Crisis management is not easy, is not what leadership anticipates and requires a massive dose of resiliency. Engage your board, community and leadership team to emerge successfully.
Rising expenses and dropping income and occupancy? The Playbook offers guidance and strategies to mitigate the financial impact of a pandemic .

11/9/20: Holiday Plans Survey For Residential Providers: As the holidays approach, we know that many members are working hard to figure out the best way to plan for celebrations, travel, and family gatherings for residents and staff. LeadingAge national wants to get a better sense of where members are landing on plans, so they have developed a short survey on residential providers' plans for accommodating residents, staff and families who want to gather together with loved ones over the holidays. If your organization provides affordable housing, assisted living, independent living, life plan/CCRC, memory support home or nursing home care, please take this 5-question survey. The deadline is Thursday, Nov 12. Thank you!

This issue remains a hot topic. Today, LeadingAge released an article that reviews Member Solutions for a COVID-Safe Thanksgiving and, very soon, a companion article on CDC and States Guidance for Thanksgiving: Travel and Gatherings will follow.

11/9/20: Suicide Prevention Training Opportunity for LTC: LeadingAge Nebraska has been contacted by the University of Nebraska Public Policy Center to participate in a training program that they have funding for related to prevention of suicide in LTC. The Partners in Preparedness group through the College of Public Health will also be included in this opportunity.

If you are interested in this opportunity, here is the link to register: https://go.unl.edu/FrontlineQPR

Click HERE for more details on the training opportunity. Contact Natalie McCormick at natalie.mccormick@leadingagene.org if you have questions!

11/9/20: BD Veritor Educational Tools: Here is a listing of BD Veritor tools with links:

Website training pages: Click Here
How to use tab on BD.com: Click here
New modes poster: Click here
Video link, YouTube (and all digital channels): Click here
Quick reference guide: Click here
Webinar register and re-watch: Click here

11/5/20: Phase 3 Provider Relief Deadline - TOMORROW: Tomorrow is the last day for providers to submit their TIN information for validation for Phase 3 Provider Relief Funding. Providers have until 11:59 p.m. EST on November 6 to submit their TIN. Once the TIN is validated they will have until 11:59 p.m. EST to submit the financial information portion of their application. The application can be accessed HERE.

On a call today with HHS there was indication that the deadline for submitting a TIN for validation is firm. There were a number of providers on today's call that asked about validation of a TIN that they had already submitted. If you submitted a TIN and you have not received any feedback on validation, please contact Nicole Fallon with LeadingAge national (nfallon@leadingage.org) as soon as possible so she can assist you. This article written by Nicole provides more background on Phase 3 of Provider Relief Funding.

11/5/20: Zoom Cancellation Reminder: The member call held jointly by LAN and NHCA with Dr. Anthone and Dr. Ashraf is cancelled for tomorrow.

11/4/20: Register for Nebraska Project ECHO ICAP Hub: Nursing Home providers, do you think that you turned in your name to participate with Project ECHO through ICAP? That was the first step in letting ICAP know of your interest, HOWEVER, you must fill out both of these forms to be officially registered (one of which was posted on the ICAP site last Thursday).

Nursing Home Participant Survey (Do not complete if you have already filled this out): https://unmcredcap.unmc.edu/redcap/surveys/?s=MA3KEEMWYP

Nursing Home ECHO Registration Authorization (Added on 10/29): https://unmcredcap.unmc.edu/redcap/surveys/?s=FP4WDLCH8R

To be registered and added to a cohort you must complete the documents by Friday, November 6, as introductory sessions will begin next week. Contact Sarah Stream at sstream@nebraskamed.com if you have questions.

11/2/20: Governor Ricketts Announces Additional Funding for LTC: Governor Ricketts announced in his 10:00 am CT press conference today that the per diem Medicaid rate for Nebraska LTC facilities (Nursing Facility and Assisted Living) will increase by $20/day and will be paid retroactive to May 1, 2020, continuing through December 31, 2020. This will total close to $40 million that will be designated to go directly to LTC facilities in the state. More details will follow. Interim Director Jeremy Brunssen indicated that he anticipates claims will be reprocessed and payments made beginning in November. He also indicated that managed care entities covering Medicaid NF and AL will be following suit.

11/2/20: Governor Ricketts Announces New Director of Division of Medicaid and Long-Term Care: Utah man has been named the new director of the Nebraska Division of Medicaid and Long-Term Care, Gov. Pete Ricketts announced Monday.

Kevin Bagley, who replaces Matthew Van Patton, who left in February, has worked for the Utah Division of Medicaid since 2011 and is the director of long-term services and supports in the division.

Holiday Travel and Family Visits and COVID: CDC has issued a variety of guidance on All Holiday Travel, Thanksgiving, Considerations for Events and Gatherings, and for People with Increased Risk Exposure. A few states have also offered guidance related to holidays. LeadingAge Nebraska is working with Nebraska Healthcare, ICAP and DHHS to assess these issues as well. More to come on this.

11/2/20: NHSN Reporting on Point-of-Care Tests: Due to overwhelming demand and limited space, CDC has announced 2 more webinars for the point-of-care test reporting through NHSN. Webinars will be held on Thursday, November 5 at 11:30pm CT and Friday, November 6 at 10:30am CT. Register HERE (and sign-on EARLY). LeadingAge national is advocating for the development of a CSV file template to allow providers or states to upload files of test results into NHSN rather than completing individual, manual data entry. It was shared today that while CDC is working on this, it is not expected any time soon. LeadingAge national has expressed the urgency of this need.

11/2/20: Phase 3 Provider Relief: The deadline for providers to get their TIN in for validation for Phase 3 funding is Friday, Nov. 6. Once validated providers will have until 11:59 p.m. EST on Nov 27 to submit the financial information portion of the application after validation. HHS noted for those providers who got stuck in Phase 2 and never got validated, at this point they should just apply for the Phase 3 funding because it offers the 2% of patient service revenue of Phase 2 plus the potential for an add-on payment over and above that amount. This may require members to call the Provider Support Line (866-569-3522) to cancel their Phase 2 application in order to apply for Phase 3. After Phase 3 closes, HHS will be making some decisions about how to proceed with remaining funds. This announcement should be expected within 30 days of Phase 3 closing. Members should apply for Phase 3 as there is no guarantee of future distributions.

11/2/20: Provider Relief Infection Control Incentive Payments: We have begun hearing from members that have received infection control incentive payments based off of their September performance. If you are a provider who believes that you should have received a payment, but did not, please contact Jenifer (jenifer.acierno@leadingagene.org) so this can be shared with LeadingAge national for further conversation with HHS.

For those of you who want to see more detail on how the incentive payments were determined, HERE is a document that includes more specificity on the Nursing Home Quality Incentive Payment Methodology.

11/2/20: Home Health Final Rule: CMS released the final CY2021 Home Health Prospective Payment System Rate Update rule last Thursday. The final rule:

Updates the payment rates for home health agencies by 2% for 2021.
Adopts the new OMB statistical area delineations while capping wage index decreases at 5% for 2021 which is consistent with CMS policy across the Medicare program.
Holds LUPA thresholds, case-mix weights, and behavior assumptions at the same levels as CY2020.
Finalizes the changes to §409.43(a) as implemented in the March 2020 IFC that states that the plan of care can and must include any provision of services furnished via telecommunications systems. The rule reiterates that visits via a telecommunications system cannot substitute for a home visit ordered as part of the plan of care and cannot count as a home visit for purposes of eligibility or payment.

The rule also discusses the new home infusion benefit, reporting on the Home Health Value Based Purchasing Program, and changes to the Conditions of Participation OASIS requirements.

11/2/20: The State of Nebraska and the Department of Health & Human Services has Announced Round 2 of Community CARES Grants: Round 2 of Community CARES Grants is open. Organizations that received a Stabilization Grant in Round 1 (awarded in July 2020) are not eligible for Round 2 funding. The only exception to this rule is Assisted Living Facilities and Long-Term Care Facilities. These two types of facilities are eligible to apply for Stabilization Round 2 funding, regardless of whether they applied for Round 1 funding. If you are a provider of long-term care services and received assistance under Round 1 of these DHHS grants, you ARE eligible to apply again under Round 2. The application deadline is November 13. Link directly to the application portal: https://mcrcares.servicenowservices.com/nebraska.

11/2/20: BREAKING NEWS: GOVERNOR RICKETTS ANNOUNCES TEMPORARY INCREASE IN MEDICAID PER DIEM Governor Ricketts announced in his 10:00 am CT press conference today that the per diem Medicaid rate for Nebraska LTC facilities (Nursing Facility and Assisted Living) will increase by $20/day and will be paid back to May 1, 2020, continuing through December 31, 2020. This will total close to $40 million that will be designated to go directly to LTC facilities in the state.

Jenifer Acierno spoke as part of the press conference and expressed her thanks to facility providers and front-line workers for all their hard work in protecting residents of LTC facilities. Nebraska has been fortunate to have amazing providers of long-term care, invaluable assistance with Nebraska ICAP and collaboration with DHHS. The Governor again stressed the importance of wearing masks, social distancing and avoiding the "3 Cs": 1) crowded places, 2) close contacts, and 3) confined spaces. Maintaining those disciplines will help keep all Nebraskans safe, and especially our most vulnerable.

10/30/20: Governor Ricketts to Announce Additional Support for Nebraska Long-Term Care Facilities: LeadingAge Nebraska long-term care members, please tune in to the Governor's press conference on Monday, Nov. 2 at 10:00 a.m. CT for an announcement important to providers of long-term care. The press conference can be viewed via live stream on NET.

10/28/20: Provider Relief Incentive Payments for September: Today HHS announced today that the first monthly Nursing Home Infection Control Incentive Payment will be sending out $333M to 10,501 nursing homes (76% of eligible nursing homes) who qualified for the incentive payment. These payments should arrive on Monday, Nov. 2. To be eligible for an Infection Control Incentive Payment, providers must first meet two "gateway" criteria: 1) the nursing home's infection rate must be lower than that of the infection rate in their county; AND 2) the nursing home's mortality rate must be less than 10% for all residents in their facility that contracted COVID-19 (includes both in-facility acquired infections as well as COVID admissions). The incentive payments are based off performance for August 31 - September 27. There will be a range of payments. HHS also shared how many facilities in each state received payments and the aggregate amount of those payments by state. LeadingAge national will be providing an article on this in the next few days.

10/28/20: Requirements for Swabbing and Self-Swabbing for POC and BinaxNow Tests: During last week's member call with Nebraska DHHS it was indicated by representatives from Nebraska DHHS that a licensed healthcare provider must do the swabbing for POC and BinaxNow tests and that self-swabbing was not allowed. This was a significant concern for LTC providers based on the workforce shortage and the many additional staff requirements related to COVID-19. On the call with DHHS today, after much conversation, it was agreed that swabbing for these tests (nasal swabbing) can be completed by a trained, but unlicensed, health care provider. This means that a CNA or Med Aide or another team member who can demonstrate competency by completing necessary training modules and demonstrating competency CAN do the swabbing. Self-swabbing is also allowed if observed by someone who is trained to do the swabbing. It is strongly recommended that documentation of training are maintained for team members doing this work.

10/28/20: Phase 2 AL Provider Relief Funds: Assisted Living's that applied under Phase 2 by last Tuesday will receive a payment this Friday. LeadingAge would like to hear if we have AL members who do NOT receive payments or who are still waiting for their TINs to be validated. Please contact your state association representative (Jenifer at jenifer.acierno@leadingagene.org) if you applied but do not receive a payment or are awaiting TIN validation.

10/28/20: Phase 3 Applications Are Low: HHS shared with LeadingAge national today that only 35,000 of a potential 1 million providers have applied for Phase 3 funding. This round of funding is opened up to any provider of health care services, and supports, including Medicare, Medicaid and private pay. The payments first ensure that providers get their 2% and then any remaining funds will be distributed as add-on payments (over and above the 2%) to providers who demonstrate more need for funds to cover coronavirus expenses and lost revenues. If fewer providers apply, the pot of funds for add-on could be a significant portion of the $20B set aside for this Phase.

10/28/20: Affordable Housing and Pharmacy Partnership: Here is a Q and A for affordable senior housing providers on the pharmacy partnership program, why affordable housing providers should fill out the REDCap form, and what this partnership might, and might not, mean for them.

10/28/20: CDC NHSN POC Test Reporting Tool Training Rescheduled: CDC has rescheduled training on the new NHSN Point of Care Test Reporting Tool. These trainings will now be held this Friday, October 30 at 1pm CT and Monday, November 2 at 11:30pm CT. The NHSN website has not been updated yet with these new dates, but once updated you will access the registration for these webinars here under "Training".

While enforcement discretion will be exercised until November 20 on this reporting requirement, it appears that discretion will only apply to those who have been unable to report through NHSN due to a lack of Level 3 access and who have initiated the process to upgrade. Reporting does not stop during the upgrade process. Providers must continue reporting to the state/local health department as previously required until they are able to report through NHSN.

10/28/20: CDC Pharmacy Partnership Program for LTC: The deadline to opt in to the Pharmacy Partnership Program for LTC has been extended to November 6. Nursing homes (including those who are part of a Life Plan Community) register through NHSN. Other providers (including the other sections of a Life Plan Community) register through the REDCap form. You received a direct email today from LeadingAge Nebraska if you were not on the list of registered facilities.

Here are some Q&As that might assist you as you determine your next steps. LeadingAge national is recommending that all providers register.

Q: Are ICF/IDD residents going to be immunized under CVS/Walgreens partnership?
A: No. The first phase includes people in nursing homes/AL/CCRCs over age 65.

Q: If a nursing home plans to work with its local or LTC pharmacy, does it do any harm for them to fill out the CVS/Walgreens application before 11/6?
A: We recommend that they fill our the form, indicate their LTC pharmacy, and then indicate CVS/Walgreens as a back-up (a back-up is required to complete the form. This way they can be linked to their LTC pharmacy, BUT if their LTC Pharmacy is not able to support them, they will still be able to be linked to vaccine.

Q: Is there any guarantee that the state will allow local/LTC pharmacies to administer the vaccine? Specifically the question from members has been that they want to use their LTC pharmacy or local pharmacy. Is there a guarantee that the residents will have the same access to vaccines as if they had used the CVS/Walgreens partnership?
A: It will vary state-to-state. Some states are backed up on-boarding providers and are prioritizing larger hospital systems. Indicate a preferred option and back-up on your form. If your LTC pharmacy is able to get vaccine through the state, then you can go that route, but many smaller LTC pharmacies have indicated that the -80 storage with a minimum order of 1000 doses may be difficult to handle and distribute.

Q: There is no CVS or Walgreens within 75 miles of my nursing home. Should I fill out the NHSN form?
A: Yes. Mapping and work is being done with a couple of smaller regional chains and state health departments to ensure coverage. Just pick whichever location is closer. You can indicate this as your back-up plan.

10/28/20: Distribution Update on HHS BinaxNOW Test Cards AND POC Testing Equipment: Abbott BinaxNOW test cards are being distributed from federal HHS to nursing homes in red and yellow positivity counties in quantities meant to enable them to complete routine testing of all staff (twice per week, once per week). Positivity rates are re-evaluated bi-weekly. Based on our Nebraska member call with DHHS today, the state distribution is focused on Nursing Facilities first and then Assisted Livings with outbreaks. Angela Ling with DHHS indicated that she is receiving outbreak information from the ICAP team. She also indicated that if an AL is in need of tests (for instance in a red county for positivity and without testing supplies) that you can reach out to her directly at angela.ling@nebraska.gov so that she can consider distribution. When you email her please include your CLIA # and the number of staff and residents at your location. She also indicated that if you do not hear back from her after 24 hours to please follow up with her.

The distribution of the Quidel and BD point-of-care testing devices is nearly complete (one more week). Questions have been received about eligibility of providers who did not have CLIA waivers when this initiative began but have since applied. HHS indicated on their call today that providers who were unable to obtain a CLIA certificate/waiver prior to September 30 "are welcome to purchase these devices from the manufacturer." So unfortunately, if a provider was not able to secure a waiver prior to September 30, they are not included in these allocations.

10/28/20: The State of Nebraska and the Department of Health & Human Services has Announced Round 2 of Community CARES Grants: Round 2 of Community CARES Grants opened last week. Organizations that received a Stabilization Grant in Round 1 (awarded in July 2020) are not eligible for Round 2 funding. The only exception to this rule is Assisted Living Facilities and Long-Term Care Facilities. These two types of facilities are eligible to apply for Stabilization Round 2 funding, regardless of whether they applied for Round 1 funding. If you are a provider of long-term care services and received assistance under Round 1 of these DHHS grants, you ARE eligible to apply again under Round 2.

Starting October 21, charities -including non-profit 501(c)(3), providers and centers of worship may apply by visiting the Coronavirus Relief Fund website. Please see tabs for each grant for eligibility, use of funds. For more information about the Coronavirus Relief Fund program visit:

https://home.treasury.gov/system/files/136/Coronavirus-Relief-Fund-Frequently-Asked-Questions.pdf.

On the state website, you can learn to apply for two grants overseen by DHHS - 1) the Stabilization Grant for Charitable Organizations & Licensed Providers and 2) the Healthy Places Grant for Centers of worship - and seven administered by the Department of Economic Development, which focus on assistance for businesses.

Link directly to the application portal: https://mcrcares.servicenowservices.com/nebraska.

Application deadline is November 13.

10/28/20: UPDATED TIME FOR NEXT WEEK'S Weekly Connection with DHHS CALL: Weekly Connection with DHHS hosted jointly by LAN and NHCA:

Wednesday, November 4, 2020 at 9:30am CTJoin: https://nehca-org.zoom.us/j/96222516275 | Or call: 669-900-9128 | Webinar ID: 962 2251 6275

10/26/20: Visitation Guidance from the State Fire Marshal: With the weather becoming colder and the positivity rate in many Nebraska counties being on the increase, please see the information provided by Doug Hohbein of the State Fire Marshal's office regarding options to help facilitate visitation. The documents reference the CMP Funding that was to be made available for this purpose. As an update, we are still waiting to hear from Medicaid regarding the availability of that funding yet this week.

Visitation Tent Requirement | Outdoor Visitation Requirement

10/26/20: Nebraska State Vaccination Plan: DHHS announced the Nebraska COVID-19 Vaccination Plan this morning. Health care workers and long-term care residents are prioritized as a part of this plan.

As was shared last week, NF and AL providers (and others that share the same location, such as IL) are eligible to sign up for the Pharmacy Partnership for Long Term Care program. If you are located within 75 miles of a CVS or Walgreens For assisted living and other providers who do not have access to NHSN, you may opt in to the Pharmacy Partnership for LTC Program by completing the RedCap form here: https://airc.cdc.gov/surveys/?s=R3TYTJDAW4. LeadingAge has also provided an article about the HHS & CDC Pharmacy Partnership Program and FAQ. Responses are being requested by 11:59pm EDT on October 29, 2020.

10/26/20: LeadingAge National Coronavirus on Wednesday Features Our Very Own Member, Jerry Nevins, of Rose Blumkin Jewish Home: Wednesday's call will feature insights from a former surveyor-turned-provider. Working with Long Term Care state surveyors can be challenging in normal times and when you add a pandemic it can be even more vexing to providers. What if you could hear from a former state surveyor and hear his thoughts on how his community is handling the challenges of COVID-19 and how to work with your surveyors during this chaotic time? Jerry Nevins from Rose Blumkin Jewish Home in Omaha will give you his ideas for what surveyors might be looking for and how you can work as a team. He will also provide ideas for how you can work with local coalitions to find needed supplies and resources like PPE. If you haven't joined us for our Coronavirus update calls, you can register here.

10/26/20: Provider Relief Updates: HHS Eliminates Prior Limits on Lost Revenues Established in Sept. Reporting Requirements: The long anticipated and hoped for revisions to the September 19 PRF Reporting Requirements arrived today and came with an explanation that the revisions were a direct result of pressure from stakeholders and Congress with the conclusion, "There is consensus among stakeholders and Members of Congress who have reached out to HHS that the PRF should allow a provider to apply PRF payments against all lost revenues without limitation." The result is that providers will no longer report on operating income changes year over year but actual change in patient care revenues from 2019 to 2020. In addition, the revised document eliminates the prior limits on the use of PRF dollars to cover lost revenues. This is an advocacy victory as we raised concerns about these provisions with HHS on numerous occasions. LeadingAge anticipates an update to the HHS FAQs in the next couple of days to reflect these changes. LeadingAge national has provided an article with a few more details.

Eligible Providers for Phase 3 Application Expanded: HHS also announced that the Phase 3 application is now open to residential treatment centers, chiropractors and eye/vision providers. They also confirmed the following providers are eligible even if private pay: nursing service and related providers, hospice providers, respiratory, developmental, rehabilitative and restorative service providers, nursing and custodial care facilities, among other providers. The website and FAQs have not been fully updated to reflect these changes yet.
HHS Announces another webinar on Phase 3 Application: HHS will be hosting another live webinar on the Phase 3 application process on. Nov. 2 at 3p ET.
Phase 2 Funds continue to go out: $90 million in PRF funds went out to 661 AL providers on Monday. This was the third wave of disbursements from the Phase 2 General Distribution process.
Bankruptcies may disqualify nursing homes from Infection Control Payments: LeadingAge has heard from some nursing home members who did not receive Infection Control Distribution dollars in late August. Upon inquiry to HHS, they were informed that providers were denied as they were on the CMS bankruptcy exclusion list. LeadingAge is continuing to advocate for these organizations to get dedicated Infection Control funds. This is one of the criteria that HHS/CMS is using to determine which providers receive funds.

10/26/20: NHSN Reporting of POC Testing: Nursing homes are now required to report point-of-care testing through NHSN, which requires SAMS level 3 access. If you are a LeadingAge Nebraska member that needs to upgrade to Level 3, you will be receiving a separate email tomorrow. CDC/NHSN have been reaching out to providers via email over the past several weeks to initiate the upgrade process. If you are not currently in the process of upgrading to Level 3, you should reach out to NHSN immediately by emailing nhsn@cdc.gov and include "POC test reporting" in the subject line.

10/26/20: Online Training Available for Community Emergency Preparedness for Older Adults and Disasters: The U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR) are offering a new web-based training that is designed to improve public health and emergency medical responder capability to address the access and functional needs of community-dwelling older adults in disasters. This new training complements ASPR's previously-released Access and Functional Needs (AFN) web-based training defines the concept and requirements for addressing the AFN of at-risk individuals, and provides tools and resources to help you address the AFN of at-risk individuals in your community during disaster preparedness, response, and recovery activities. The trainings are at-your-own-pace and free, although participants will need to create an account in the TRAIN system to access training. Additional information regarding the training is available here.

10/26/20: States Begin Detailing Specific Use of 150 Million BinaxNOW COVID-19 Tests: Four weeks after HHS announced the nation-wide deployment of 150 million state-of-the-art Abbott BinaxNOW rapid point-of-care tests to assist Governors' reopening efforts, states have begun to report where they are distributing these tests. To view the allocation of tests to each state and territories click here.

10/26/20: Considerations for Use of SARS-CoV-2 Antigen Testing in Nursing Homes: This document provides a summary of considerations for use of SARS-CoV-2 (the virus that causes COVID-19) antigen testing in nursing homes and is intended for nursing home providers and state and local public health departments.

10/26/20: Senate Finance Committee Chairs Letter to HHS Regarding Alzheimer's Project Goal for Cure by 2025: The end of last week Senators Toomey (R-PA) and Stabenow (D-MI), Chair and Ranking Member of the Health Subcommittee of the Senate Finance Committee, released a letter to HHS Secretary Azar with recommendations to "promote care coordination for Alzheimer's disease patients enrolled in federal health programs, improve disease detection, enhance the affordability and accessibility of long-term care, strengthen protections for vulnerable individuals, and incentivize the development of cures." These recommendations were based on comments received by over 30 experts and stakeholders, including LeadingAge national. A number of LeadingAge recommendations were adopted, in whole or in part, including directing CMMI to develop an alternative payment model for managing care for persons with AD/RD, improving and expanding access to the PACE program, encouraging use of the care planning code available for AD/RD. Other recommendations include increasing care coordination, improving access to palliative care, developing quality indicators for dementia care services, increasing availability of telehealth services for dementia care in nursing homes, and a number of recommendations around improving research and innovation in care and services.

10/26/20: The State of Nebraska and the Department of Health & Human Services has Announced Round 2 of Community CARES Grants: Round 2 of Community CARES Grants opened last week. Organizations that received a Stabilization Grant in Round 1 (awarded in July 2020) are not eligible for Round 2 funding. The only exception to this rule is Assisted Living Facilities and Long-Term Care Facilities. These two types of facilities are eligible to apply for Stabilization Round 2 funding, regardless of whether they applied for Round 1 funding. If you are a provider of long-term care services and received assistance under Round 1 of these DHHS grants, you ARE eligible to apply again under Round 2.

Link directly to the application portal: https://mcrcares.servicenowservices.com/nebraska.

Application deadline is November 13.

10/21/20: *If you missed today's member call with DHHS, here are a few of the items that were updated.

It was indicated that at this point in time only licensed health care professionals can administer and run the POC testing. More to come with clarification on who this includes.
DHHS does not support the process of self-swabbing for testing but will continue to seek additional information on this.
Surveyor testing plans are still being implemented.
There is still NOT an AL Infection Control template approved/ready for distribution.
No update on whether NHSN reporting for POC will be sufficient to replace the duplicate state reporting yet.

DHMs for Phase 3.1 Go Into Effect for All Nebraska Counties TODAY: As announced by the Governor last Thursday, all Nebraska counties are in Phase 3.1 through November 30 starting October 21. The move to Phase 3.1 applies to every health department jurisdiction in the state.

Here is an outline of changes to DHMs effective 10/21/2020-11/30/2020.

10/21/20: Reporting POC Testing Through NHSN: HHS has updated the Lab Data Reporting Requirements document to specify that nursing homes must report point-of-care testing through NHSN. Level 3 access in NHSN is required to report this data. Providers who do not have level 3 access or are not currently in the process of updating to Level 3 should reach out to nhsn@cdc.gov immediately (approximately 9,000 nursing homes have level 3 access currently). This does not prohibit a state from continuing to require this reporting take place through a state-specified platform, though CMS and CDC are hopeful that states will transition to this reporting mechanism to satisfy lab data reporting requirements. Read the updated requirement here (note that the document is updated though the data still reads "June 4"). PLEASE NOTE: The trainings on the NHSN Point of Care Test Reporting Tool scheduled for Thursday October 22nd and Friday October 23rd are cancelled but will be rescheduled. Information regarding the new dates and times will be communicated as soon as they are identified. In the meantime, questions related to the NHSN Point of Care Test Reporting Tool for long-term care facilities can be sent to NHSN@cdc.gov with the subject line of "POC test reporting". Providers should be aware of enforcement. It appears that CMS will be enforcing only whether you report positive/negative results, but CLIA will enforce the full 18 required data elements. Remember that tests must be reported within 24 hours.

10/21/20: Updated Guidance Defining Exposure to COVID-19 - Cumulative Total of 15 Minutes or More: CDC issued updated guidance to clarify the amount of time it would take for someone to be considered a close contact exposed to a person with COVID-19. The updated guidance now defines a close contact as someone who has spent a cumulative total of 15 minutes or more, in a 24-hour period within six feet of an infected person. Previous guidance defined a close contact as someone who spent at least 15 consecutive minutes within 6 feet of a confirmed case.

10/21/20: Overview of Testing for SARS-CoV-2 (COVID-19): CDC updated guidance on the appropriate use of testing for SARS-CoV-2 in light of additional testing capacity throughout the country. CDC updated their COVID-19 testing overview with information on viral and antibody tests.

10/21/20: Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes: Here is the most recent update of the CMS Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes. It includes recent information and guidance on vaccinations to prevent infection with influenza virus, pneumococcus, and SARS-CoV-2, the virus that causes COVID-19.

10/21/20: Pharmacy Partnership for Long-Term Care Program: For assisted living and other providers who do not have access to NHSN, you may opt in to the Pharmacy Partnership for LTC Program by completing the RedCap form here: https://airc.cdc.gov/surveys/?s=R3TYTJDAW4. LeadingAge has also provided an article about the HHS & CDC Pharmacy Partnership Program. Responses are being requested by 11:59pm EDT on October 29, 2020.

10/21/20: CDC Partnership Program for Vaccines- CVS and Walgreens

*Repeat from Monday's update* CDC is launching a partnership with CVS and Walgreens to provide vaccine services in nursing homes and assisted living once a COVID-19 vaccine has been approved and authorized. Participation in this program is free of charge. According to CDC, participating in this partnership will provide nursing homes and ALs with end-to-end support in the process of vaccinating residents against COVID-19.

Beginning October 19, providers will have the opportunity to choose to partner with either CVS or Walgreens. Nursing homes will indicate pharmacy preference through the NHSN portal. ALs will indicate pharmacy preference through an online REDcap (https://redcap.link/ltcf) sign-up form.
Once vaccination of this population launches, pharmacies will provide 3 vaccine clinics on-site at the nursing home/AL over a period of approximately 2 months in order to provide a 2-step vaccine to all residents and any staff who were not previously vaccinated.
The pharmacy will take responsibility for acquiring vaccines and associated supplies (including PPE).
The pharmacy will manage cold-chain storage for the vaccine.
The pharmacy will take responsibility for required vaccine reporting.

Nursing homes and assisted living facilities are not required to participate in this program. They may opt out through the same channels described above for signing up. However, if a nursing home or assisted living opts out of this program, they must have a plan in place to ensure vaccination of their population through alternative channels such as a state vaccine program or local pharmacy. State/local jurisdictions were required to submit vaccine plans by today and CDC will post these plans publicly later this month.

10/21/20: The State of Nebraska and the Department of Health & Human Services has Announced Round 2 of Community CARES Grants: If you read the LeadingAge Nebraska COVID-19 Update on Monday night, you would have seen a reference to the second round of Community CARES Grants through DHHS. Application for the funding opens today and ends November 13, 2020.

Organizations that received a Stabilization Grant in Round 1 (awarded in July 2020) are not eligible for Round 2 funding. The only exception to this rule is Assisted Living Facilities and Long-Term Care Facilities. These two types of facilities are eligible to apply for Stabilization Round 2 funding, regardless of whether they applied for Round 1 funding. If you are a provider of long-term care services and received assistance under Round 1 of these DHHS grants, you ARE eligible to apply again under Round 2.

Starting TODAY, October 21, charities -including non-profit 501(c)(3), providers and centers of worship may apply by visiting the Coronavirus Relief Fund website. Please see tabs for each grant for eligibility, use of funds. For more information about the Coronavirus Relief Fund program visit:

https://home.treasury.gov/system/files/136/Coronavirus-Relief-Fund-Frequently-Asked-Questions.pdf.

Link directly to the application portal: https://mcrcares.servicenowservices.com/nebraska.

Application deadline is November 13.

Program Overview: Charitable organizations and care providers across the state have struggled in the wake of COVID-19. The Community CARES Stabilization Grant offers organizations working capital to help them cover operating expenses such as PPE, rent and utilities. This will enable our charities and licensed/certified providers to continue serving Nebraska's children, families and communities.

Most eligible entities will receive $12,000. Organizations in areas disproportionately impacted by COVID-19 will receive $27,000. Disproportionately impacted areas are determined by DHHS through analysis of COVID-19 cases per capita, per zip code as of June 30, 2020. Grantees will be notified of their award amount at the time of award notification.

Eligible Assisted Living Facilities and Long-Term Care Facilities, licensed by DHHS, will be awarded funds based on their licensed bed capacity. Award amounts will be announced at a later date.

Data Sharing Authorization: By submitting an application, applicants certify and authorize the Nebraska Department of Revenue to release certain tax return information to the Nebraska Department of Health and Human Services. This information may be used to process this application or for audit purposes.

Additional Information: For more information about the Coronavirus Relief Fund program visit https://home.treasury.gov/system/files/136/Coronavirus-Relief-Fund-Frequently-Asked-Questions.pdf.

10/19/20: CDC Partnership Program for Vaccines- CVS and Walgreens: CDC is launching a partnership with CVS and Walgreens to provide vaccine services in nursing homes and assisted living once a COVID-19 vaccine has been approved and authorized. Participation in this program is free of charge. According to CDC, participating in this partnership will provide nursing homes and ALs with end-to-end support in the process of vaccinating residents against COVID-19.

Beginning October 19, providers will have the opportunity to choose to partner with either CVS or Walgreens. Nursing homes will indicate pharmacy preference through the NHSN portal. ALs will indicate pharmacy preference through an online REDcap (https://redcap.link/ltcf) sign-up form.
Once vaccination of this population launches, pharmacies will provide 3 vaccine clinics on-site at the nursing home/AL over a period of approximately 2 months in order to provide a 2-step vaccine to all residents and any staff who were not previously vaccinated.
The pharmacy will take responsibility for acquiring vaccines and associated supplies (including PPE).
The pharmacy will manage cold-chain storage for the vaccine.
The pharmacy will take responsibility for required vaccine reporting.

10/19/20: State Makes Additional CARES Funds Available: PROVIDERS OF Nursing Facility and Assisted Living Services ARE ELIGIBLE: Today Governor Ricketts announced the allocation plan for the remainder of Nebraska's CARE Act funds, which originally totaled $1.084 billion, to address coronavirus response. This round will provide assistance to non-profits, healthcare providers, and Nebraska businesses.

Community CARES Grant Program
- $48.5 million of additional funds will be awarded to assist non-profits and care providers as they respond to needs arising from the coronavirus pandemic.
- According to DHHS, eligible licensed assisted living facilities and long-term care facilities will be awarded funds based on their licensed bed capacity (if they apply). Award amounts will be announced at a later date.

All nursing and assisted living facilities are eligible to apply for Stabilization Round 2 funding, regardless of whether they applied for Round 1 funding. Other organizations that received a Stabilization Grant in Round 1 (awarded July 2020) are not eligible for Round 2 funding.
Round 2 funding may be used to support expenses necessary to continue business operations and include eligible expenses, not limited to those incurred since March 13, 2020, for normal business operations, such as rent, utilities, and payroll. Round 2 funds also may be used for COVID-19-related expenses, such as PPE and cleaning supplies.
Grant applications open on October 21, 2020 and will close November 13, 2020. To apply, visit coronavirus.nebraska.gov/Programs&Grants. The grants will be issued by December 30, 2020.

10/19/20: Nursing Home Testing Rule: Comments are due November 2 on CMS-3401-IFC, the testing rule. LeadingAge will be commenting on the following topics and ask you to please share feedback with Jenifer (jenifer.acierno@leadingagene.org) by Thursday, October 22.

Burden of testing requirements: LeadingAge is hearing that the main barriers to testing are the cost of testing, the significant staff time required to complete testing, and access issues including access to rapid turn-around test results. Routine staff testing (based on county positivity rates) seems to be the biggest pain point, with additional concerns around the low threshold for triggering outbreak testing.
Lack of surveyor testing: LeadingAge sent a letter to CMS on this topic a few weeks ago and plan to include in our comments. We advocate for testing of surveyors, since surveyors are in nursing homes including resident care areas, have close contact with both residents and staff, are observing COVID-19 testing, and live in communities (just like our staff) that may have high positivity rates.
Burden of reporting requirements: Point-of-care testing requires additional reporting according to CLIA requirements. CDC now allows for this reporting to be done through the NHSN platform; however, each state is responsible for adopting their own reporting process and are not required to utilize the NHSN option.
Barriers of unnecessary CMPs: LeadingAge has long criticized the use of CMPs. We feel that punishing by taking money away from the provider is detrimental to the quality improvement process.

10/19/20: NHSN Reporting on COVID-19 Testing: As was reported last week, CDC has built capability into NHSN to allow for reporting of point-of-care testing data in a way that would meet HHS Lab Data Reporting requirements. Last week, LeadingAge national confirmed with CMS that a state would have to adopt this method of reporting to meet requirements because no federal requirement existed. CDC announced that reporting through NHSN will become the required method of reporting. This is a step toward that goal of streamlined reporting.

HOWEVER-

States may still require reporting through their own platforms. CDC does not support duplicative reporting.
Reporting through NHSN will require that upgrade to the level 3 security access. If a provider has not yet been contacted by NHSN to initiate this process, they can email nhsn@cdc.gov to request to get started. According to CDC, CMS intends to be flexible with those who have made a good faith effort to make their way through this security upgrade.

Check out this article by LeadingAge for more information, including a link to updated guidance from CDC on point-of-care testing. The ability to report through NHSN DOES NOT relieve the provider of requirements to report point-of-care testing according through the process outlined by their state (per CLIA requirements). CDC will host 2 webinars on this change next week (October 22 and October 23). Read the Table of Instructions for data element information and register for the webinars here.

10/19/20: Provider Relief Fund Nursing Home Infection Control Incentive Payments: HHS announced that their calculations for September show that 65-70% of nursing homes will qualify for a Nursing Home Infection control Incentive Payment to be issued by the end of October. It originally appeared that HHS would set aside 20% of the $400 million monthly to provide incentive payments based upon nursing homes' performance on a mortality measure. The disadvantage of this approach is providers with no infections and therefore no deaths from infection (a good thing) would not have been eligible for these funds. HHS explained late last week that instead of setting aside those payments, it will first determine which nursing homes meet the gateway criteria on infection rate and mortality. Then it will calculate a total infection control score which will be made up of the infection rate measure performance score modified based upon mortality performance, as applicable. The adjustment to the overall score will be no more/less than 20% for mortality.

HHS noted that nursing homes have already shown a 5% improvement on infection control between August and September. Only 127 homes did not pass the mortality gateway, while 122 others who had deaths in their facilities will still qualify for an incentive payment once they complete their outreach to determine which COVID deaths were from infections obtained from within the nursing home versus those who were admitted with COVID.

HHS did not yet provide the range of incentive payments but anticipates that payments may begin the week of October 27. We are hoping that more information will be made available so members can calculate or at least better understand what data is being used to calculate these incentive payments. More to follow as it becomes available.

10/19/20: Telehealth: On October 14, CMS expanded the list of telehealth services that Medicare Fee-for-Service will pay for during the COVID-19 Public Health Emergency (PHE). These new telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services. The list of these newly added services is available on the List of Telehealth Services webpage.

CMS also released a new supplement to its State Medicaid & CHIP Telehealth Toolkit, Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version that provides numerous new examples and insights into lessons learned from states that implemented telehealth changes. The updated supplemental information is intended to help states strategically think through how they explain and clarify to providers and other stakeholders which policies are temporary or permanent. It also helps states identify services that can be accessed through telehealth, which providers may deliver those services, the ways providers may use in order to deliver services through telehealth, as well as the circumstances under which telehealth can be reimbursed once the PHE expires. They also released a preliminary data snapshot on Medicaid and CHIP telehealth utilization during the pandemic.

10/19/20: Hospice Guidance on Contracting for Core Services: On October 5, the Centers for Medicare & Medicaid Services (CMS) issued memorandum QSO-21-01 Hospice-"Nursing Shortage as an 'Extraordinary Circumstance' per 42 CFR 418.64 CORE SERVICES" to State Survey Agency Directors. CMS has issued memoranda authorizing use of contracted staff under extraordinary or other non-routine circumstances as authorized under the "extraordinary circumstances" core services provisions at 42 CFR 418.64 on a regular basis over recent years based on the ongoing nursing shortage. The most recent memo, issued in 2018, was applicable through September 30, 2020. The October 5th memo does not have an expiration date for the authority and does not explicitly limit the use of contract staff to nursing so could be used, when applicable, for counseling and social work staff as well as long as the other requirements of the guidance are met.

10/19/20: CMS Ties Lab Payment for PCR Tests to Turnaround Time: CMS announced this evening that starting January 1, 2021, Medicare will pay laboratories the current $100 for COVID-19 PCR tests only if labs turn them around within 48 hours. Labs will receive $75 to conduct each test. Those that meet the two day requirement will receive an additional $25. Labs that take longer than two days will only receive $75 per test.

10/19/20: BD Resources for Reporting and Batch Testing: BD shared with LeadingAge some new resources last week on the BD website for reporting and batch testing. The reporting updates cover the different options for connectivity on Veritor: https://www.bdveritor.com/long-term-care-facilities/reporting-long-term-care-facilities/

For batch testing, there is a video tutorial of the process on this training page: https://www.bdveritor.com/long-term-care-facilities/training/

10/19/20: Update on USPS/ Postal Carrier Screening: Questions have come up in some of our weekly member calls regarding the status of mail delivery and postal carrier screening. Early on, LeadingAge had sent on a note to the Post Master inquiring about this. HERE is the response letter from the Post Master. Options related to mail delivery are included and have not changed.

10/19/20: HUD Service Coordinator Reporting Deadline Extended: HUD has announced a one-month extension of the Standards for Success reporting requirements for 2020. Originally due at the end of October, the reports are now due on November 30th. HUD staff will join the regular LeadingAge Housing Advisory Group call on Monday, October 26th to share more updates about Service Coordinators, including payment and grant extension updates. To join the call, email jbilowich@leadingage.org.

10/14/20: DHHS Update on Test Nebraska and More: During today's Member Call with DHHS, Becky Wisell shared that there was an updated Test Nebraska testing calendar available for Nursing Facilities. You can find it here. Keep in mind that the dates identified are the dates that your tests are to be IN the lab, not the day that you are to test. It was also indicated that in the next few days a letter will be coming out from DHHS that includes the testing capacity for NPHL and Test Nebraska for things like confirmatory testing that require a 48 hour turn around time. The letter can be used as you document attempts to meet testing requirements based on your county positivity rate (color).

DHHS is still working on both the BinaxNOW distribution playbook and the Assisted Living Infection Control document. In relation to the BinaxNOW plan, Assisted Living facilities that had not completed the DHHS survey regarding number of residents and staff received a follow up email from Becky yesterday. If you received the email again and have not completed the survey, please do so. Here is the link to the survey. They are asking for surveys to be completed by 5pm on Thursday. The survey will help in determining distribution of the test cards, including to your facility.

The DHHS team is still working to add the comment column to the reporting document that is being used to provide test results to the state, there will likely be an update on this during our Friday weekly Member Call with Dr. Anthone, Dr. Ashraf and others. There is more to come on surveyor testing in Nebraska as well, as plans are being put in place to begin testing surveyors.

10/14/20: CDC Information on COVID-19 Vaccines: LeadingAge is hearing from some state health departments advising members to start working on their plans for COVID-19 vaccination. Unfortunately, not a lot of official and detailed information is available at this time. There is currently no approved or authorized vaccine. Many are under development or various stages of trials at this time and a vaccine may be available in the coming months, potentially under an emergency use authorization. CDC put out a few documents over the past 24 hours that are available here. Here is a quick overview of the main points:

4 vaccines are currently in large-scale clinical trials. Of these 4 vaccines, 3 of them require 2 shots and 1 vaccine is a single-shot vaccine.
Supply may be limited initially. CDC's advisory committee is considering recommending prioritization of the following groups:
- Healthcare personnel
- Workers in essential and critical industries
- People at high risk for sever illness due to underlying medical conditions
- People aged 65 and older

The government is aiming for free and low-cost vaccines. Providers will be able to bill for administration of the vaccine.
Safety monitoring for adverse effects of the vaccine will take place through a number of platforms, including NHSN.
At this time, it has not been determined whether an individual who has recovered from COVID-19 will be recommended to receive a vaccine. There is limited information about natural immunity at this time, and it will also depend upon the vaccine that is ultimately approved.
The vaccine is not the key to returning to "normal life." Vaccines help the body fight the virus if exposed. Masks and social distancing are necessary to limit exposure and transmission. We will need to continue to mask and social distance, even after a vaccine is approved.

10/14/20: NHSN Reporting on Point-of-Care Testing: Beginning this Friday, October 16, providers will have the opportunity to report COVID-19 point-of-care testing through NHSN. Our understanding is that this will require the enhanced security of upgrade to Level 3 (SAMS grid card) in the NHSN system. CDC is hosting 2 webinars next week to share more information: Thursday, October 22 at 10:00am CST and Friday, October 23 at 1:00pm CST. Registration information is available here. It is important to note that this capability does not replace required reporting according to CLIA requirements. Providers must continue to report point-of-care testing according to the process outlined by your state. States will make the decision as to whether to adopt NHSN as the reporting platform.

10/14/20: Provider Relief Phase 3 Webinar: A reminder that HHS is hosting a Provider Relief Fund Phase 3 Informational Webinar. Phase 3 has been referred to informally as the clean up phase. Here is a fact sheet on Phase 3. Register here for the free webinar, set for tomorrow, Thursday October 15 at 2:00 CST. Applications for Phase 3 will be accepted through November 6. Apply as soon as possible to expedite processing and payment.

10/14/20: LTC Discussion Group to Feature Making Care Work Pay: The DC-based Long-Term Care Discussion Group, a policy group that meets monthly to share LTC financing and policy information, will feature Robyn Stone and Beth Almeida at its October 20 meeting. The meeting is set for 10:00 AM - 11:00 CST. If you are interested individuals can join at this Zoom link: https://zoom.us/j/95974411114

10/14/20: New HUD FAQs discuss COVID-19 testing, MORs: HUD has issued updated COVID-19 FAQs for Multifamily Housing providers, including HUD Section 202 and Section 8 providers. The agency had last issued updated FAQs on July 31. HUD's newest FAQs for Multifamily Housing providers include updated guidance on the CDC's order to halt evictions, offering COVID-19 tests and flu shots on premises, and REAC inspections and MORs. LeadingAge will continue to work with HUD to support housing providers navigating the pandemic. A summary of the FAQs is available here.

10/14/20: PPE Opportunity- Glove and Medical Grade Facemasks: We have been distributing PPE received from a number of generous donors. Most recently we have received items from our friends at DonatePPE. If you are in need of any of the following items, please email me (jenifer.acierno@leadingagene.org). Here is the PPE that is currently available.

Vinyl gloves, size small. Each container includes 10 boxes of 100 gloves.
Medical grade face masks.

10/12/20: IRS Extends Non-Filer EIP Deadline Until Nov. 21: For the last time, according to the IRS, it has extended the deadline for non-filers to register to receive Economic Impact Payments from the IRS. Millions of non-filers were left out of receiving these stimulus checks but are nonetheless eligible for them. To receive these payments, they must register to do so by November 21.

10/12/20: Project ECHO Material for Nursing Home Members: If you are interested in some additional information about Project ECHO's National Nursing Home Action Network, HERE is a FAQ fact sheet that includes links to learn more and register to participate. HERE is a shorter version of the basics with a link to get more information and connect to a hub or center. Finally, HERE is the flyer on the half hour introductory webinar that will be repeated on October 13, 14, or 15.

10/12/20: Streamlined Forgiveness for Small PPP Loans: The Treasury and SBA announced a new forgiveness application for PPP loans of $50,000 or smaller- the smallest of the PPP loans. Under this new application, borrowers will need to certify that they used their loan funds in compliance with federal law and regulation but do not need to submit detailed data on how the loan funds were used. Loans of larger amounts still need to be processed through the regular or EZ application forms, both of which require reporting of how loan funds were used. See more here.

10/12/20: Provider Relief Fund: LeadingAge has written an article covering the changes on the interpretation of "hiring" for the purposes of eligible expenses under the Nursing Home Infection Control Distribution and covering additional information that HHS has posted regarding the Phase 3 General Distribution application process. As part of the article and listed separately on the LeadingAge COVID-19 page, is a table that summarizes the distributions to aging services providers from the PRF to date in an effort to help them track the allowable purposes for each set of funds received.

10/12/20: BD Veritor Batch Testing Training: Here is the recording of our latest training with BD staff on the BD Veritor system and batch testing. During this comprehensive training, BD experts explained how to properly use the BD Veritor system and utilize its batch testing process to simplify and help manage testing time commitments.

10/12/20: CDC Recommendations for Posting About Confirmed Cases: In response to questions about how long to leave up notices regarding confirmed cases on site, CDC staff have recommended that housing providers consult the following guidance for the discontinuation of isolation of persons not in healthcare settings. According to the CDC staff, as long as the only reason why the COVID-19 notices are posted is to signify that someone is potentially infectious, then the signs can come down as soon as that person has met criteria to discontinue isolation, i.e., the length of time discussed in the guidance available here.

10/12/20: CMS Announces New Repayment Terms for Medicare Loans Made to Providers During COVID-19: CMS announced a one year grace period for repayment of loans/advance payments received by providers. Payments are to begin one year from the issuance date of each provider or supplier's accelerated or advance payment. The amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program was passed by Congress and signed into law by the President as part of the Continuing Resolution. The Medicare loan program had allowed CMS to make advance payments to providers and is typically used in emergency situations. Under the Continuing Appropriations Act, 2021 and Other Extensions Act repayment will now begin one year from the issuance date of each provider or supplier's accelerated or advance payment. CMS issued $106 billion in payments to providers and suppliers in order to alleviate the financial burden healthcare providers faced while experiencing cash flow issues in the early stages of combating the COVID-19 Public Health Emergency (PHE). For more information, CMS released a Fact Sheet and FAQs related to the Accelerated and Advance Payment Repayment and Recovery terms.

10/12/20: Information on Self-Collecting Anterior Nasal Samples for Health Care Providers: The FDA issued a letter to health care providers recommending that health care providers give clear, step-by-step instructions to patients who, in a health care setting, are self-collecting anterior nasal samples for SARS-CoV-2 testing. Without proper instructions, patients may not collect an adequate sample for testing, which may decrease the sensitivity of the test.

10/12/20: Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes: CMS updated the toolkit on state actions, including recent information and guidance on vaccinations to prevent infection with influenza virus, pneumococcus, and SARS-CoV-2, the virus that causes COVID-19.

10/12/20: Fight the Flu Vaccine Campaign Kickoff: HHS has developed this set of tools to spread the word - Getting an annual flu vaccine is more important than ever this fall. #FightFlu by getting vaccinated today. Say #BooToTheFlu: During the month of October, use #BooToTheFlu to encourage others to get their flu vaccine by Halloween. More Info:"Boo To The Flu" Toolkit.

10/12/20: CDC Issues Eviction Ban FAQs: The CDC has issued FAQs for the eviction moratorium in place from September 4th through December 30th. The FAQs were issued jointly by the CDC, HUD, the Department of Health and Human Services (HHS), and the Department of Justice (DOJ); the document discusses the declaration used by tenants to certify eligibility for the protections, as well as timing for housing providers initiating evictions, among other outstanding questions. More information will be available HERE.

10/12/20: CDC Eviction Moratorium Resident Declaration: The CDC has posted the resident declaration, required of tenants seeking protection of the CDC's eviction moratorium for non-payment of rent, in twenty languages.

10/12/20: Weekly Senior Housing Recap for the week ending 10/9/2020. Here's your weekly senior housing recap.

10/12/20: Weekly Nursing Home Recap for the week ending 10/9/2020. Here's your weekly nursing home recap.

10/9/20: LTC LAB Calendar link

10/7/20: DHHS Updates from Today's Member Call: During the member call with DHHS today, Becky Wisell indicated that the Baseline Testing link for Test NE is being removed from the DHHS website. She also recommended that facilities not direct PCR testing needs to Test NE due to a current staffing issue with the lab. If tests are submitted to Test NE she indicated to be prepared for an extended turn around time for results. IF you have a need a back-up for testing to move in to Phase 3, reach out to Becky Wisell, Dan Taylor, or Connie Vogt. If you need a PCR or a timely alternative.

It was indicated that ALs are not required to do testing, however, if an AL received BinaxNOW testing supplies AND plans to do testing, the results of those tests are required to be submitted to DHHS under the same reporting guidelines provided to NFs.

Facilities should be on the look out for an updated Test Ne LTC testing calendar.

If you are a NF and have not yet received a Quidel or BD Veritor machine, please contact Jenifer- jenifer.acierno@leadingagene.org.

10/7/20: Survey Regarding Assisted-Living Facility Resident and Staffing Count: Becky Wisell sent the following note out to AL providers today:

An e-mail was sent out this afternoon by DHHS employee Brian Harter. The e-mail includes a link to a Survey Monkey survey in which DHHS is asking all assisted-living facilities to identify the number of staff and residents for your facility. This information is being used in the development of the plan for distributing the Abbott BinaxNOW antigen test cards. We have asked that all assisted-living facilities complete the survey before noon on Thursday, October 8, 2020. I apologize for not providing more clear identification with the survey, but I want you to know the link provided by Brian is legitimate and we would appreciate your response. Thank you.

10/7/20: Provider Relief Funds new FAQs on Infection Control fund uses and Phase 3 Application Clarifications: HHS clarified in its recently updated FAQs on Provider Relief that the Nursing Home Infection Control Payments can be used to hire AND retain staff. The Terms and Conditions for the Nursing Home Infection Control limit use of payments to certain infection control expenses, including hiring staff, whether employees or independent contractors, to provide patient care or administrative support. Is "hiring" limited to only bringing on new staff or may funds be used for existing staff? (Added 10/5/2020)

Payments from the Nursing Home Infection Control Distribution may be used to cover "hiring" expenses related to both recruiting new hires and the continued payment and retention of existing staff to provide patient care or administrative support.

The FAQs also provide additional details regarding the Phase 3 application process. The FAQs clarify that HHS will review all the applications prior to distributing any of the $20B from this tranche. So, this means these payments won't make their way to providers until mid to late November at the earliest. The goal appears to be to ensure all eligible providers first get their full 2 % and then provide add-on payments to those who demonstrate continued need beyond what has been received to date.

10/7/20: BD Veritor Batch Training for LeadingAge Members: Register for our BD Veritor Batch Testing Training. Please join representatives from Becton Dickinson(BD) for a second session on the point of care (POC) antigen testing machine, Veritor. The session will be held Thursday, October 8th at 2:00pm CST. You will learn about the Veritor and advanced usage in batching. Register for the training here.

10/7/20: Project ECHO Sign Up: The National Nursing Home COVID-19 Action Network is an opportunity for nursing homes to voluntarily join a Project ECHO learning collaborative. Participants will work in small groups, with teams of four staff from each nursing home joining weekly calls to hear from experts and to share information with other participating nursing homes about what they've tried and how it has worked. Participating nursing homes will receive $6,000 each. There will be other ways to sign up, but currently the website is linked here.

10/7/20: Voting: CMS released this memo this week, reminding nursing homes of residents' rights to vote. The memo describes some different options for voting. Providers should be supporting residents to exercise the right to vote in this and all elections. LeadingAge has developed a "What's Your Voting Plan" toolkit that provides an easy to use self-assessment for both aging services providers and individuals to develop a plan to vote for this year's election.

10/7/20: CDC FAQ on Nursing Home Testing: CDC updated an FAQ to include new information on Nursing Home Testing. In particular, providers should refer to the question on infection prevention and control measures for those who receive a positive antigen test result followed by a negative PCR result. Several factors need to be considered when determining how to proceed, and we know this has been a source of confusion/frustration with members and their health departments.

10/5/20: Public Health Emergency Extended: Last week, HHS Secretary Alex Azar announced that he is extending the COVID-19 Public Health Emergency for another 90 days, effective October 23rd, 2020. This date ensures continuity of the PHE flexibilities (including 1135 waivers) that are in place. The PHE will now be in place until at least January 21, 2021 and the flexibilities allowed to providers will continue unless specifically ended by HHS or CMS.

10/5/20: Visitation Tool: CMS released updated visitation guidance on September 17. Over the past 2 weeks, CMS has been working with states to address conflicts between CMS guidance and state mandates. LeadingAge has created this quick reference tool to help refresh providers on the CMS guidelines for visitation as states issue updates that are more aligned with federal guidance.

10/5/20: Project ECHO Network Introductory Session: An introductory session will be offered multiple times over the next two weeks to learn about the ECHO National Nursing Home COVID-19 Action Network. To learn more about the Network and project ECHO, nursing home providers can pick the date and time that works best for them. More information and webinar date choices are outlined in this flyer. The network is open to any nursing home in the country at no cost. The network will work with nursing home staff and administrators from across the country to share best practices, learn from peers, and hear from experts on nursing homes and quality improvement. Nursing homes that are eligible to receive Provider Relief Funds can receive $6,000 for participating. Many of you have heard about this opportunity from Dr. Ashraf and team and have already indicated your intention to participate in this network.

10/5/20: BD Veritor Batch Training for LeadingAge Members: Register for our BD Veritor Batch Testing Training. Please join representatives from Becton Dickinson(BD) for a second session on the point of care (POC) antigen testing machine, Veritor. The session will be held Thursday, October 8th at 2:00pm CST. You will learn about the Veritor and advanced usage in batching. Register for the training here. More on BinaxNOW Cards: Admiral Brett Giroir, Assistance Secretary for Health and the Administration's Coronavirus testing lead was featured on today's LeadingAge Coronavirus Call. The recording of today's call can be accessed here. Among other highlights, he indicated that Binax tests are going out weekly to nursing homes and assisted living communities that have CLIA waivers and are in red (and some yellow) zones. If a provider meets those two criteria and has not received Binax test cards, they can email HHSbinax@HHS.gov. It is likely the inbox will have/receive a lot of traffic. Please let Jenifer know if you have additional problems.

It was also indicated that nursing facilities had through September 30 to get CLIA waivers in order to received the BD or Quidel POC testing machines that will be rolling out in October. This is for those that have not yet received testing equipment.

10/5/20: Home Health and Hospice distribution of Binax Cards- SURVEY: Please respond to this survey. LeadingAge sent an email today to home health and hospice members with a survey asking for information requested by HHS in order to assist with the distribution of Abbott BinaxNOW testing cards to these provider types. If you are a LeadingAge Nebraska home health or hospice member, please complete the survey by Friday October 9. Completion of the survey does not guarantee that an agency will receive the Abbott BinaxNOW cards, but the information will be helpful in facilitating this if possible.

10/5/20: CDC Update on Transmission: CDC updated guidance today on the transmission of COVID-19 to include airborne transmission. Airborne transmission means virus hangs in the air for minutes or even hours and can infect people further than 6 feet away or after the infected person has left the area. Evidence indicates that when airborne transmission has occurred, it has been in enclosed spaces with inadequate ventilation. Airborne transmission is uncommon. Close contact is still the most common source of spread of COVID-19. This new information highlights the importance of adequate ventilation and source control (masking of nose and mouth, social distancing). Here are 4 things providers can do:

Stress the importance of masks and social distancing with residents/patients, staff, and visitors.
Talk with your building engineer about ventilation.
Bring in fresh outdoor air as much as possible.
Allow ample time before entering spaces for cleaning and turn-over. Check out this CDC guide on air changes / hour for airborne contaminant removal.

10/5/20: Provider Relief Phase 3 Application: The application process for Phase 3 opened today and will remain open until 11:59p ET on Nov. 6. Phase 3 is open to all providers who have applied before and received a full 2% General Distribution, in addition to all other previously eligible providers. There are two newly eligible groups for this application: 1) behavioral health providers including those who are exclusively private pay and/or accept commercial insurance, and 2) providers who opened/began delivering care in the first quarter of 2020. Providers are encouraged to apply early as the distribution process is also different this time with a two-step process. The first step will be to review applicants to ensure they receive a full 2% payment in combination with any prior general distribution payments received. After that, HHS will seek to "calculate an equitable add-on payment" for providers demonstrating a continuing need for funds. All providers seeking funds in Phase 3 must submit an application and this application will require providers to submit additional information to support their financial losses and increased expenditures due to the coronavirus. LeadingAge is awaiting further information about HHS webinars that will provide additional instruction about the application process. This Phase 3 Primer pulls together all the new information from the HHS website regarding the Phase 3 application.

10/5/20: Housing Providers & Collaboration with Community Health Centers: LeadingAge hosted the National Association of Community Health Centers to discuss opportunities for collaborations. Staff from the health center association described how federally qualified health centers got their start and how they can partner with housing providers to improve resident health, on COVID-19, the flu, and more. First step for housing providers: Locate your community health center, and ask what kind of health services they provide (or may be able to start providing) for the older adults in your community. More information is available here.

10/5/20: Hospice FY 2021 Medicare Rate Tool: Members now have access to Medicare rate tool for hospice services updated for fiscal year (FY) 2021. This incorporates the 2.4% rate update from the final rule and calculates the rates for routine home care, general inpatient care, continuous home care, and respite care by core-based statistical area (CBSA). Member login (national) is required to access the tool.

10/5/20: PPE Opportunity- GLOVES or Medical Grade Face Masks, anyone? We have been distributing PPE received from a number of generous donors. Most recently we have received items from our friends at DonatePPE. If you are in need of any of the following items, please email me (jenifer.acierno@leadingagene.org). This PPE is intended to be prioritized for providers who are having challenges securing items through their regular distribution chain. Here is the PPE that is currently available:

49 containers of vinyl gloves, size small. Each container includes 10 boxes of 100 gloves.
2500 medical grade face masks.

10/5/20: Affordable Housing Weekly Recap. Here is your affordable housing weekly recap for last week. Nursing Home Weekly Recap. Here is your nursing home weekly recap for last week.

10/1/20: Take the LeadingAge affordable senior housing survey today! Affordable senior housing providers: Let's help each other! To inform our housing policy work, LeadingAge is circulating a quick survey about the impacts of COVID-19 on affordable senior communities. The survey information will help us advance our policy priorities, like securing COVID-19 relief payments and increasing internet connectivity options at HUD communities. The deadline for completing the survey is Wednesday, October 7; the survey should take about 3 minutes to complete and each question is optional. Thank you for taking a moment to complete the survey.

9/30/20: Resources for Wednesday's call:

9/30/20: OBRA PDPM October 1, 2020 Assessment Information for Nebraska: If you were able to join us for the member call with DHHS this morning, you heard Dawn Sybrant discussing the anticipated changes related to MDS, effective October 1, 2020. Dawn indicated that there will be a few week period during which the transition will be allowed. DHHS - MLTC (Department of Health and Human Services - Medicaid and Long Term Care) will require the completion and submission of specific MDS item set fields associated with PDPM on all OBRA nursing home comprehensive, quarterly, significant change in status and significant correction to prior comprehensive or quarterly MDS assessment submissions. MLTC believes this is a necessary step to begin evaluating the PDPM classification system and its viability as an alternative for the Resource Utilization Group-III (RUG-III) classification system.

Nebraska will not be using the OSA (Optional State Assessment).

HERE is the OBRA PDPM document that contains additional detail provided by Dawn. Please share with your MDS Coordinators.

9/30/20: From Livanta QIO: FY 2021 Final Rule: CMS-1735-F: Federal regulations under FY 2021 Final Rule: CMS-1735-F now require ALL providers to transmit medical records and other documentation (like the Notices of Non-Coverage) to the Beneficiary and Family Centered Care - Quality Improvement Organizations (BFCC-QIOs) electronically using an electronic submission method determined by the QIO. Providers will now be reimbursed a flat rate of $3 per case for the electronic submission.

Beginning October 1, 2020, Livanta will accept medical records electronically in two ways. Providers may choose which method is best for them and submit medical records accordingly. For more information see HERE.

9/30/20: CMS Memo on Emergency Prep Guidance: CMS released a memo reiterating guidance around the emergency preparedness rule for all providers that was finalized in September 2019. This rule allowed an exemption from completing a full-scale or functional exercise if a provider had activated its emergency plan in response to an actual natural or man-made disaster. The memo clarifies that the COVID-19 PHE qualifies as a disaster and providers qualify for the exemption if they can demonstrate through written documentation that the emergency plan has been activated. LeadingAge has provided a summary of the new memo here, which will be available tomorrow. This applies to the following types of LeadingAge member providers: home health, inpatient hospice, ICF/IDD, nursing homes, and PACE.

9/30/20: CMS Press Release on Testing Frequency Data: CMS put out a press release describing updates to the methodology for determining testing frequency based on county positivity rates. As noted previously, the data had been adjusted to include 14 days of data, rather than the initial 7 days. Testing frequency color codes were adjusted for certain counties with low testing rates. LeadingAge has prepared additional information HERE, which will be available tomorrow.

During our member call today with DHHS the question came up as to whether the adjusted color codes should also be used for determining eligibility for indoor visitation. While it sounds as if CMS is endorsing this approach, we are awaiting specific direction from NE DHHS on this, as CMS has not yet provided that information in writing. Connie Vogt indicated that they would be raising this issue with CMS Region VII on a call this week. More to follow.

9/30/20: PPE Opportunity- GLOVES, anyone? We have been distributing PPE received from a number of generous donors. Most recently we have received items from our friends at DonatePPE. If you are in need of any of the following items, please email me (jenifer.acierno@leadingagene.org). This PPE is intended to be prioritized for providers who are having challenges securing items through their regular distribution chain. Here is the PPE that is currently available.

49 containers of vinyl gloves, size small. Each container includes 10 boxes of 100 gloves.

9/28/20: NHSN Upgrades: In past COVID-19 updates, information has been included related to upgrading to NHSN enrollment to Level 3 security, which requires a SAMS grid card. Members are encouraged to pursue the enhanced security, as it it likely that this upgrade will allow nursing homes to report on patient-level data ("such as SARS-CoV-2 test results"), rather than simply reporting facility-level data as is done currently. This may provide some streamlining to reporting. The process to upgrade may take a few weeks. During that time providers will still be able to submit weekly reports using your level 1 enrollment while you complete the process of upgrading to level 3. Instructions on how to upgrade enrollment can be found here.

CDC will be updating NHSN to collect data on flu vaccines. CDC sent an email to NHSN users and will be hosting 2 webinars to go over these changes:

Webinar 1: Thursday, October 1 at 12:00pm CST. Register here.

Webinar 2: Tuesday, October 6 at 12:00pm CST. Register here.

9/28/20: BD Batching Guide: If you participated in the BD Veritor training offered by LeadingAge a week or so ago, there was a reference to a batching guide. BD has just released this batching guide for use with the Veritor machine.

9/28/20: Abbott BinaxNow Slides: Abbott partnered to offer a training on the Abbott BinaxNOW tests for home health and hospice organizations. The slides from the webinar can be found here. Distribution plans for the test kits are not yet known, however, remember that a CLIA CLIA certificate of waiver will be necessary to receive and administer these tests intended for staff of home health and hospice organizations.

9/28/20: Register NOW for Virtual Update on DOL Leave Rule: * FREE to LeadingAge Members* Please register and join LeadingAge for a Virtual Update on the Revised Regulation on COVID-19 Employee Leave on Tuesday, September 29 at 1pm CST. The virtual update will provide an overview of the revised regulation clarifying workers' rights and employers' responsibilities under the Families First Coronavirus Response Act paid leave provisions and hit on the following topics:

Changes to the definition of which employees may be exempted from the paid sick leave and FMLA leave.
Considerations for when your employees must provide notice, what documentation is expected, and if employees can take leave on an intermittent basis.
Learn how to determine if an employee is "otherwise available to work", which employees are considered a "health care provider" and which are eligible for paid leave.
Understand the records you must keep as an employer and how to be reimbursed for leave taken by your employees

9/28/20: Project ECHO: The formal roll out of the ECHO National Nursing Home COVID-19 Action Network will start next week. We have heard from Dr. Ashraf regarding this project on a number of our calls. The HHS Agency for Healthcare Research and Quality (AHRQ) is funding this initiative, in collaboration with CMS and CDC. Funds from the Provider Relief Fund will be used to pay the stipends to participating nursing homes. AHRQ has provided this flyer with information for nursing home members.

9/28/20: Updated Infection Control Tool: Since the new visitation guidance came out, LeadingAge has updated the Infection Control Survey Tool and Checklist to include a few additional considerations. CMS has not revised the CMS tool for visitation since September 2. Check out the updated LeadingAge tool here.

9/28/20: HUD COVID-19 Payment Update for Senior Housing Providers: HUD has completed reviews of all COVID-19 Supplemental Payment (CSP) requests received last month and has now obligated approved amounts to individual rental assistance contracts. HUD expects payments to begin flowing to properties next week and that most should receive funds by October 7. HUD will be providing email notifications to individual properties confirming request status. The payment mechanism is the same as standard rental assistance through LOCCs or via the contract administrator. More information about CSPs is available here.

9/28/20: Updated Heroes Act introduced in House: This evening, House Democrats released an updated version of the Heroes Act with a price tag of $2.2 trillion, down from the original $3 trillion. The bill retains funds for states to enhance wages for essential workers, including health care workers; Paycheck Protection Program improvements; housing assistance; and funding for states to establish and implement strike teams to deploy to nursing homes within 3 days of three residents or employees being diagnosed with or suspected of having COVID. Here is a press release and here is a section by section analysis.

9/28/20: Nursing Home Weekly Update: Here is the nursing home recap for last week.

9/28/20: Affordable Housing Weekly Update: Here is your affordable housing recap for last week.

9/28/20: PPE Opportunity: We have been distributing PPE received from a number of generous donors. Most recently we have received items from our friends at DonatePPE. If you are in need of any of the following items, please email me (jenifer.acierno@leadingagene.org). This PPE is intended to be prioritized for providers who are having challenges securing items through their regular distribution chain. Here is the PPE that is currently available.

49 containers of vinyl gloves. Each container includes 10 boxes of 100 gloves.
Currently enroute - 2500 medical grade masks. If you'd like to get on the list for medical grade masks let me know and I can add you to the list.

9/23/20: Nebraska DHHS Releases Testing Plan: If you were able to join our Wednesday Member Call with DHHS you heard that the Nursing Facility Testing Plan was that was being developed would be released today. This evening the Nursing Facility Testing Plan rolled out. This document applies specifically to Nursing Facilities, not to Assisted Living. More information will be forthcoming related to Assisted Living facilities.

The Nursing Facility Testing Plan outlines testing for both staff and residents, including prioritization of individuals for testing. The State is offering testing through Test Nebraska to all nursing homes, on a specifically timed basis. They will provide related test kits, PPE for those performing testing, and laboratory processing though CHI St. Elizabeth Lab. Use of Test Nebraska for testing may not satisfy the frequency requirements for testing depending on the positivity rate requirements for each location. Test Nebraska testing can be used to help facilitate necessary testing, especially in cases where POC equipment and tests are not yet available, have been exhausted, or other testing options are unavailable. There is a LTC Lab calendar attachment included that sets out specific days for testing for each Nebraska NF. Check the calendar to see when the Test Nebraska testing is available to your facility.

LeadingAge Nebraska was able to obtain the following information related to testing equipment:

If a facility that has not yet received POC testing equipment, but has a CLIA Waiver, LeadingAge was able to confirm with CMS that additional equipment will begin shipping on October 1, 2020 for those facilities that did not have the CLIA Waiver in place in time to be on the earlier list of providers receiving equipment.
If you have questions related to testing equipment, including receipt of equipment and testing you can email DNH_TriageTeam@cms.hhs.gov. Please provide your CLIA certificate number and CCN on the email.

LeadingAge (national) was able to get clarification from CMS on a number of issues, many of which arose on our Member Call today, including the following:

General indoor visits are restricted in the midst of an outbreak/outbreak testing. Indoor compassionate care visits may continue in the midst of an outbreak/outbreak testing. Remember compassionate care visits should be exceptional, but are at the discretion of the nursing home.
The most recently-released CMS data on county positivity rates were adjusted to account for low rates of testing. Approximately 350 counties with low rates of testing were placed in the lower testing frequency category than the positivity rate would otherwise indicate because the high positivity rate is determined to be a factor of low rates of testing rather than high rates of viral transmission. For example, a county may have a positivity rate of 23%, but be color-coded as yellow (medium). Nursing homes are to follow the color-code for testing frequency. CMS states that nursing homes may also follow the color-code for visitation. So in the above example, the nursing home may continue to offer indoor visitation if no other exclusionary criteria are met. We are awaiting confirmation from NE DHHS that they have received the same direction.
The new guidance states that residents who are on transmission-based precautions should not have in-person visits (indoor or outdoor) except in compassionate care situations. We clarified that this includes residents who are on transmission-based precautions solely due to recent admission/readmission.

9/23/20: COVID-19 Testing Resources for Nursing Homes: If you are looking for guidance/resources related to testing. Here is a quick reference page from CDC that may help.

9/23/20: REMINDER-Training with Quidel Experts on Sofia COVID-19 Testing: LeadingAge is offering an exclusive training on the Quidel Sofia analyzers tomorrow, Thursday, September 24 at 2:00 PM CT. As with the BD Veritor training, Quidel trainers will demonstrate how to use the machine, provide details on batch testing, and answer member questions. LeadingAge nursing facility subject matter experts, Jodi Eyigor and Janine Finck-Boyle will be on hand to answer member questions about the CMS Interim Final Rule and other topics. You can register for the training here.

9/23/20: Updates to NHSN Reporting: CDC will soon be updating the COVID-19 module on NHSN to include data elements on flu vaccines. CMS confirmed that data elements on flu vaccines are not mandatory but are strongly encouraged. It would require regulatory action to make this reporting mandatory. Expect to see these new data elements in the next week or so. Providers should check out the Tables of Instructions located on the NHSN site under "Data Collection Forms and Instructions" to be sure that you are responding appropriately to these and other data elements. Providers can also find instructions for increasing their SAMS level access on this site under "Enhancing Data Security."

9/23/20: PPE Opportunity: We received a few hundred N95 masks from our friends at DonatePPE. If you are in need of N95s, size large, please email me (jenifer.acierno@leadingagene.org) and let me know the number of masks that you need for immediate use. These supplies are intended to meet the needs of members who are unable to secure N95 masks otherwise.

9/21/20: MS Revises Visitation Guidance to Allow More Visitation Options: On September 17, 2020, the Centers for Medicare and Medicaid Services (CMS) released revised visitation guidance for nursing homes during the COVID-19 Public Health Emergency. The Nursing Home Visitation - COVID-19 QSO-20-39-NH provides guidelines, core principles and best practices for nursing home visitation both indoors and outdoors. As nursing homes prepare for either type of visitation, they must continue to adhere to screening protocols for all who enter, practice hand hygiene, wear face coverings or masks, maintain social distancing, wear appropriate PPE, clean and disinfect high touch surfaces and areas, create cohorting of COVID positive residents and comply with CMS regulations for staff and resident testing. In addition. For more information, see this LeadingAge article.

9/21/20: HHS Issues PRF Reporting Guidance with Limits on Lost Revenue: HHS issued its long-awaited Provider Relief Fund (PRF) Reporting Requirements Saturday, September 19, specifying the data that providers who received more than $10,000 in PRF payments will be required to submit as part of a post-payment reporting process. Providers should call their attention specifically to how HHS plans to calculate and limit the use of payments for lost revenues. For more information, see this LeadingAge article.

9/21/20: COVID-19 Testing Resources for Nursing Homes: If you are looking for guidance/resources related to testing. Here is a quick reference page from CDC that may help.

9/21/20: Abbott BinaxNOW Testing Webinar & Resources: A number of participants asked for the slides presented and you will find them HERE. Additionally, here are some useful links and critical contact information:

To report shipping issues / order quality concerns (these should be sent to Abbott at: ARDxUSGovernmentSupport@abbott.com)
For technical usage questions about the BinaxNOW™ test, contact Abbott directly at: Technical support: ts.scr@abbott.com or 1-800-257-9525
For all other questions related to your distribution, please contact HHSBINAX@hhs.gov, this inbox was established to coordinate the distribution of government procured Abbott BinaxNOW™kits. This inbox should NOT be used to request kits for facilities not currently receiving these tests.
For training videos & documentation and other important links, please refer the following information:
- For access to access training videos and documents, please visit the BinaxNOW COVID-19 Ag Card and NAVICA App Set-Up and Training portal.
- For CLIA FAQs and information, click here.
- For policy regarding performance of antigen tests authorized by the FDA under an Emergency Use Authorization (EUA) at the point of care or in patient care settings operating under a CLIA Certificate of Waiver, please refer to CMS's policy here and PREP Act guidance here.
- For FDA recommendations to health care providers who are ordering authorized tests outside their authorization (e.g., antigen tests for asymptomatic individuals), please see FDA's FAQ on Testing for SARS-CoV-2.

9/21/20: COVID-19 Hospice Respite Care Relief Act of 2020 Introduced in the House: Representatives Troy Balderson (R-OH) and Donna Shalala (D-FL) introduced a House companion to S. 4423, the COVID-19 Hospice Respite Care Relief Act of 2020, making this important legislation bicameral and bipartisan. The COVID-19 Hospice Respite Care Relief Act of 2020 would provide the Secretary of Health and Human Services (HHS) with the authority to make the hospice respite care benefit more flexible during any public health emergency, including the current COVID-19 pandemic. This legislation would allow the HHS Secretary to modify the existing benefit during a public health emergency by allowing respite care for up to 15 consecutive days and by allowing respite care to occur outside of the inpatient setting. LeadingAge thanks Rep Balderson and Rep Shalala for their work with us in getting this bill introduced in the House. A press release with more details can be found here and an article here.

9/18/20: *CLARIFICATION on the CMS Call TODAY* Per CMS, the CMS stakeholder call today will cover issues related to kidney disease and cancer, NOT specific Nursing Home issues or visitation.

There will be a call on Monday for nursing home stakeholders, which will include information related to nursing home issues.

This week, the Centers for Medicare & Medicaid Services (CMS) received the final report from the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission), which was facilitated by MITRE. LeadingAge has prepared the associated article. CMS also released an overview of the robust public health actions the agency has taken to date to combat the spread of the coronavirus disease 2019 (COVID-19) in nursing homes. The Commission's findings align with the actions the Trump Administration and CMS have taken to contain the spread of the virus and to safeguard nursing home residents from the ongoing threat of the COVID-19 pandemic. This announcement delivers on the Administration's commitments to keeping nursing home residents safe and to transparency for the American people in the face of this unprecedented pandemic.

Please join CMS Chief Medical Officer Lee Fleisher, MD and agency officials for a National Stakeholder Call with Nursing Homes to discuss the announcement, Monday, September 21st from 2:00 - 2:30 PM Eastern (1-1:30 CST).

Toll Free Dial-In Number: (833) 614-0820, Conference ID: 7883929

Conference lines are limited, so we encourage you to join via webcast: https://protect2.fireeye.com/url?k=8777ef6c-db23c647-8777de53-0cc47a6d17cc-0bc7372546fd785c&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2592

Press Release: https://www.cms.gov/newsroom/press-releases/independent-nursing-home-covid-19-commission-findings-validate-unprecedented-federal-response
Full Independent Coronavirus Commission for Safety and Quality in Nursing Homes report: https://edit.cms.gov/files/document/covid-final-nh-commission-report.pdf
Trump Administration Response to Commission Findings: https://edit.cms.gov/files/document/covid-independent-nursing-home-covid-19-federal-response.pdf
COVID-19 Guidance and Updates for Nursing Homes during COVID-19: https://edit.cms.gov/files/document/covid-guidance-and-updates-nursing-homes-during-covid-19.pdf

9/18/20: Member Weekly Update Call for TODAY IS CANCELLED: THIS CALL WILL RESUME NEXT WEEK- COVID-19 weekly member connections via Zoom on Fridays at 11:00 a.m. CT. As schedules permit, Special Guests Governor Pete Ricketts, Dr. Gary Anthone, and Dr. Salman Ashraf will also participate and provide state updates on the virus. Time will be allotted for discussion and questions.

9/17/20: *Supplemental COVID-19 Update* Big NEWS this evening: 1) CMS drops visitation and incentive payment guidelines with a call scheduled regarding visitation guidelines tomorrow; 2) Abbott sets BinaxNow test training for AL (NF can participate) tomorrow; 3) Reminder of LeadingAge exclusive training for members with BD tomorrow; 4) Quidel schedules testing training with LeadingAge members next week.

9/17/20: BD Veritor Training Session for LeadingAge Nursing Home Members: LeadingAge has invited BD to deliver a LeadingAge exclusive training on the BD Veritor System. The BD Veritor Training Session will be held Friday, September 18 at 2:00 CST. This free training will provide key information on: (1) Rapid antigen testing for COVID-19; (2) How the BD Veritor Plus System works; and (3) Key information on how to get support from BD on test results and accuracy. There will be a demonstration from BD staff and then a live Q and A session for members. The second part of the training will be with LeadingAge staff and cover Infection Control and other key topics. LeadingAge members may register for the training at: https://attendee.gotowebinar.com/register/8909746650265252622.

9/17/20: Abbott BinaxNow (cards) Webinar: Abbott has indicated that they have shipped about 1 million BinaxNow (card) tests to SNF operators and 540,000 to assisted living providers with CLIA waivers. Home health providers will be on a future distribution list. HHS has not issued a distribution plan in writing.

LeadingAge received notice this afternoon from the HHS Binax Team that they will offer a webinar tomorrow, September 18, from Noon - 1:00 Eastern, for assisted living facilities receiving Abbott BinaxNOW tests from HHS. Presumably this will help nursing homes as well. The webinar will "walk through the manufacturer's training, introduce the product, and discuss use in assisted living facilities. During the webinar, Abbott will demonstrate the training tools available and representatives from the U.S. government will be online to speak about the program. Use the following link to register for the training: click here to register." The webinar will accompany 10,000 registrants. The session will be recorded and available for review and shared. You can also access the Abbott BinaxNOW training portal here.

9/17/20: Save the date: Quidel Training: Training with Quidel Experts on Sofia COVID-19 Testing on Thursday, September 24 at 2:00 PM CST. LeadingAge will partner with Quidel to offer a LeadingAge exclusive training on the Quidel Sofia analyzers. As with the BD Veritor training, Quidel trainers will demonstrate how to use the machine, provide details on batch testing, and answer member questions. Jodi and Janine will be on hand to answer member questions about the CMS Interim Final Rule and other topics. You can register for the training here.

9/17/20: Visitation Memo & CMS Call: CMS dropped the revised Visitation Guidance this evening. The memo, effective immediately, will allow indoor visitation to begin. Visitation can be conducted through different means based on a facility's structure and residents' needs. The guidance requires screening of all who enter the community, but it does not require testing. Visitation is based on county positivity rates. The memo authorizes the use of CMP funds to help support in-person visits. A maximum of $3,000 per nursing home may be used for tents and clear dividers. LeadingAge will have a more detailed article available soon.

Presumably the Stakeholder Meeting scheduled by CMS tomorrow will cover the Visitation memo. It is scheduled for 12:30 PM CST. Please join Centers for Medicare and Medicaid Services Administrator Seema Verma and Innovation Center Director Brad Smith for a National Stakeholder Call on Friday, September 18th from 1:30 - 2:00 PM Eastern (12:30-1:00 CST).

Toll-Free Attendee Dial In: 833-614-0820, Conference ID: 7799256

Conference lines are limited, so we encourage you to join via webcast: https://protect2.fireeye.com/url?k=df2cc01e-8379c9ce-df2cf121-0cc47a6a52de-55b1add5b6c87a2d&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=2582

9/17/20: HHS Announced the Nursing Home Incentive Payment Program Details: Today CMS released information on the incentive payment program on the CARES Act Provider Relief Fund website under General Information and Allocation for SNFs and Nursing Homes. LeadingAge has developed an article on the details that will be available soon.

Nursing homes will need to pass two key gateways before they are eligible for the funds: 1) their infection rate for non-admission related COVID needs to be less than the county rate; and 2) their mortality rate for non-admission COVID deaths must be less than a national benchmark set by HHS, which has not yet been defined. Modeling on these two factors showed that roughly 75% of nursing homes would qualify for some level of incentive payment. There are still some gaps related to the data points and formulas to be used. More to follow.

9/17/20: Admiral Giroir on LeadingAge National Member Call: Admiral Brett Giroir, MD, Administration testing lead will speak directly to LeadingAge members on the LeadingAge Coronavirus Update Call at 2:30 CST on Monday, September 21. Should we be using antigen testing for surveillance? What's your PCR testing experience lately, looking for shorter turnaround times? How long will you have to wait for BD test kits? If you offer assisted living services and do not have a CLIA waiver, how can you get Abbot BinaxNOW tests? Will home health providers or hospice providers receive Abbott cards? Join the LeadingAge Coronavirus Update Call at 3:30 Eastern on Monday, September 21 to hear answers to these and other questions related to testing. (Note: this is not a session on the CMS Interim Final Rule.) If you aren't already registered for these calls, you can register here.

9/16/20: Abbott Invoice Error: If you received invoices for Abbott BinaxNOW (Abbott card) tests disregard them. Abbott has indicated that the invoices are a mistake. Do not submit payment. These are the test cards that HHS is providing at no cost. Abbott has agreed to conduct a training for LeadingAge members on using the test kits; more information will be made available when details are known. Just a reminder, providers, including both assisted living and nursing home, must have a CLIA waiver to use these tests. The distribution plan for these tests has still not been made available.

9/16/20: CMS PACE FAQs: CMS issued new FAQs for PACE organizations on September 15. See the LeadingAge article on the FAQs here: https://www.leadingage.org/regulation/cms-issues-new-faqs-pace-organizations. CMS provided answers to questions in three areas: overnight care in a PACE center, COVID-19 case reporting requirements, and waivers from PACE regulations.

9/16/20: Voting Plan Toolkit Released by LeadingAge: This year is a major election year and the COVID1-19 pandemic has changed the way that voters can access the polls this year. LeadingAge has developed a "What's Your Voting Plan" toolkit that provides an easy to use self-assessment for both aging services providers and individuals to develop a plan to vote for this year's election. You can download the toolkit here.

LeadingAge has also developed an online Civic Action Center that will provide accurate and reliable information about voting and the upcoming election. By visiting www.leadingage.org/votingplan members of the public will be able to:

Check their status as a registered voter
Provide tools to register to vote in the voter's home state
Give access to the forms and deadlines to request a mail-in (absentee) ballot to be submitted through the mail or dropped off at an election collection point
Find out the location of their local polling station
Learn about the candidates running for office in the upcoming election

Many states have started mail-in voting and early voting will be starting soon.

9/16/20: UNMC ID Nursing Home Project ECHO: You have likely heard on either the ICAP calls or through some of our member calls about the opportunity to learn about comprehensive COVID-19 prevention and containment program from some of the most experienced infection prevention and control experts in the state.

Preparations are underway for the launch of Nursing Home Project ECHO which will be focused on COVID-19 prevention and containment training. This will provide an opportunity for nursing homes to train their own COVID-19 prevention and containment experts. There will be many nursing home ECHO hubs across the country so nursing homes may be receive several recruitment offers. Each hub will be following the same core curriculum for training. However, each hub will have a different group of facilitators and subject matter experts who will conduct these training sessions. Under the leadership of Dr. Muhammad Salman Ashraf, the medical director for Nebraska ICAP, UNMC ID division is establishing one of the hubs in Nebraska. Nursing home team members enrolled in UNMC ID Project ECHO hub will be able to receive their training from infection control experts who are familiar to you.

Nursing Home Project ECHO is meant to provide nursing home healthcare workers access to subject matter experts for expanding their knowledge in the areas of infection prevention and control and quality improvement. It consists of 90-minutes weekly teleECHO training sessions using the Zoom platform for 16 weeks. Nursing homes will also have the option to participate in 60 minute optional weekly session for the rest of the year. Nursing homes will participate in these training as a cohort. Each cohort will consist of 33 to 34 nursing homes. Project ECHO participants will have a chance to work with their cohort peers to develop best practices and discuss particular issues within their facilities. Project ECHO HUB team will be available for questions and resources between the ECHO training sessions. Funding will also be made available to nursing homes to compensate for some of the healthcare worker time spent on the training. Each LTCF will nominate 3 to 4 healthcare workers to get trained (e.g. medical director, nurse/infection preventionist, quality team representative or other staff interested in getting involved in quality improvement process). They will also receive training certificates at the end of the training.

UNMC ID Nursing Home Project ECHO hub has reported that 150 nursing homes have already reserved their spot to participate. If a nursing home has not yet reserved a spot for project ECHO, they can use the following link to submit an application. https://unmcredcap.unmc.edu/redcap/surveys/?s=4RRCXDAJLM.

9/16/20: Slides for today's call:

9/16/20: BD Veritor Training Session for LeadingAge Nursing Home Members: LeadingAge has invited BD to deliver a LeadingAge exclusive training on the BD Veritor System. The BD Veritor Training Session will be held Friday, September 18 at 2:00 CST. This free training will provide key information on:

(1) Rapid antigen testing for COVID-19;
(2) How the BD Veritor Plus System works; and
(3) Key information on how to get support from BD on test results and accuracy.

There will be a demonstration from BD staff and then a live Q and A session for members. The second part of the training will be with LeadingAge staff and cover Infection Control and other key topics. LeadingAge members may register for the training at: https://attendee.gotowebinar.com/register/8909746650265252622.

9/14/20: BD Veritor Training Session for LeadingAge Nursing Home Members: LeadingAge has invited BD to deliver a LeadingAge exclusive training on the BD Veritor System. The BD Veritor Training Session will be held Friday, September 18 at 3:00 EST. This free training will provide key information on: (1) Rapid antigen testing for COVID-19; (2) How the BD Veritor Plus System works; and (3) Key information on how to get support from BD on test results and accuracy. There will be a demonstration from BD staff and then a live Q and A session for members. The second part of the training will be with LeadingAge staff and cover Infection Control and other key topics. LeadingAge members may register for the training at: https://attendee.gotowebinar.com/register/8909746650265252622.

9/14/20: Update and Feedback (SURVEY) Requested on Point of Care Antigen Testing: As we discussed in last week's Friday member call there have been some limited reports of false positives related to the BD POC testing. In an effort to better understand this, LeadingAge national and AHCA are coordinating efforts by asking nursing homes to complete a short survey on their BD and Quidel antigen POC testing. Please take the survey ASAP.

Members should continue to use these POC tests but we encourage members to follow the CDC guidance and algorithm on when to conduct confirmation testing of positive antigen tests.
Members may email BD at Technical_Services@bd.com with questions related to testing concerns.
BD offers this microsite and these training webinars for members to review if you are having concerns with accuracy or want more information on instructions.

9/14/20: Is the COVID data that you are reporting to NHSN Correct? Today I heard from Dr. Ishrat Kamal-Ahmed with the DHHS Epidemiology Data group that while doing some random comparisons of information it appears that some facilities are submitting their COVID data incorrectly to NHSN. When this happens, the CMS website shows wrong data for the facility and the state receives inquiries from the public and the media. A few examples that she gave are reporting of staff deaths or rolling numbers in from a previous day. Dr. Kamal-Ahmed is asking that you take a look at the links below in an effort to make sure that you are reporting correctly:

https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/covid19-dq-508.pdf

https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/faq-cms-datarelease-508.pdf

Dr. Kamal-Ahmed notes that there is an 11-day delay between NHSN and CMS. Corrections made in NHSN will show up on CMS website after 11 days. She has shared the information related to the delay in corrected information to Connie Vogt as well.

9/14/20: CFO Hotline Report - Ziegler: Join the LeadingAge provider member national call on Wednesday, September 16 to hear special guest speaker, Lisa McCracken, give an insider's view of the just-released CFO Hotline Report. Lisa is the Director of Senior Living Research and Development for Ziegler, and she has kept her fingers on the financial pulse of senior living providers throughout the pandemic. This special report reviews data submitted by the CFOs of over 230 not-for-profit providers, and focuses on of-the-moment trends in occupancy, revenue shortfalls due to COVID, staff turnover, and marketing techniques to boost sales in a post-COVID world. Get the latest on these and other key market trends that directly concern you, our members, straight from the source! And take advantage of the time with Lisa to ask your own questions about the findings. If you're not already registered for Update Calls, you can register here.

9/14/20: Some Good News-MFAR Withdrawn: CMS announced this afternoon that it will not move forward with the proposed Medicaid Fiscal Accountability Regulation (MFAR). This was the proposed rule from earlier this year that had implications for nursing home bed taxes/tax exemptions for CCRCs, supplemental payment/UPL demonstrations and Medicaid IGT/CPEs. About 4,000 public comments were submitted in response to the proposal back in January and more than half mentioned nursing homes, CCRCs and/or LeadingAge. LeadingAge national was an amazing advocate for members on this issue. Nebraska joined in this effort as well. Thanks to each of you who gave of your time and shared your voice as well. You can read more here.

9/14/20: Provider Relief Fund for Private Pay Assisted Living and Nursing Home Providers EXTENDED: HHS has extended the deadline for applications from private pay (no Medicare and no Medicaid funds) assisted living and nursing home communities. The new deadline has not yet been provided, but will likely be Monday, September 21. If you fall in this category and have not yet started the process, you should work to get your TIN information submitted. Here is the link to the portal.

9/14/20: DOL Limits Definition of "Health Care" Employee: Based on the striking down of some of the provisions in the Department of Labor regulation related to the implementation of the paid sick leave and FMLA provisions, DOL will issue a revised rule on September 16, effective immediately.

Employees who are no longer exempt or excluded from paid leave are "Individuals who provide services that affect, but are not integrated into, the provision of patient care because they do not provide health care services, such as information technology (IT) professionals, building maintenance staff, human resources personnel, cooks, food service workers, records managers, consultants, and billers".

Employees who provide "diagnostic, preventive, treatment services, or other services that are integrated with and necessary to the provision of patient care are health care providers." This includes professionals like doctors, nurses, nursing assistants, but may also include non-professionals who provide "for example, bathing, dressing, hand feeding, taking vital signs, setting up medical equipment for procedures, and transporting patients and samples. These tasks must be integrated and necessary to the provision of patient care, which significantly limits this category."

LeadingAge is updating their FAQs on this, which means there will be more to follow. Remember, you should consult with your HR and legal departments to adapt to these changes.

9/14/20: CDC Releases COVID-19 Recommendations for Multifamily Housing Providers: The new CDC webpage covers COVID-19 safety issues in HUD-assisted senior housing. Read more HERE.

9/14/20: PPE Opportunity: We received a few hundred N95 masks from our friends at DonatePPE. If you are in need of N95s, please email me (jenifer.acierno@leadingagene.org) and let me know the number of masks that you need for immediate use. These supplies are intended to meet the needs of members who are unable to secure N95 masks otherwise.

9/9/20: Grace Period for Lab Reporting & QSEP Training: If you were able to join the CMS call last evening or the LAN member call this morning with DHHS, you likely heard a reference to a potential three-week grace period for reporting. Based on feedback from the CMS Lab Excellence team today, it has been confirmed that laboratories have a one-time, three-week grace period to allow facilities to get their systems and processes in place prior to start reporting. This grace period is specific to reporting (not testing) and DOES apply to nursing facilities with CLIA Certificates of Waiver. The grace period started on September 2, 2020 and ends on September 23, 2020.

Here is the slide deck from last evening's CMS call. The three-week grace period is referenced on page 15.

This information has been brought to the attention of NE DHHS as well. More information to come.

During the call today, Becky Wisell referenced QSEP training that had just been made available. The links provided are links to the same training that we had shared with members previously for the modules related to Targeted COVID-19 Training for Frontline Nursing Home Staff and Management. Here is the link that Becky shared today: https://qsep.cms.gov/welcome.aspx.

9/9/20: HUD Staff on LeadingAge Call on Service Coordinator Payments: Today, LeadingAge hosted a call with HUD staff to address member concerns about the upcoming deadline for CARES Act payments for grant-funded Service Coordinators. Two key agency staff from HUD Headquarters joined nearly 100 LeadingAge members to discuss the timeline and eligible uses of the one-time supplemental COVID-19 payments to current grantees. The deadline to apply through GrantSolutions is this Friday, September 11th, at 11:59pm EST. More information is available here.

9/9/20: Updated COVID-19 Infection Control Survey Tool and Checklist: With the implementation of the new testing requirements, CMS updated the COVID-19 Infection Control Focused Survey tool. LeadingAge completed updates on the LA supplemental survey tool and checklist last week and it is still available as a great resource for your review. You can access the updated tool, which includes the updated CMS tool, here.

9/9/20: PPE Opportunity: In the next few weeks it appears that we will have some SMALL and MEDIUM VINYL gloves available to LeadingAge Nebraska members. If you are in need of these items, please email me (jenifer.acierno@leadingagene.org) to let me know. Please indicated how many VINYL gloves in SMALL and MEDIUM sizes that you NEED. These are meant to meet the need for members that are unable to secure VINYL gloves otherwise.

9/3/20: ICAP Call Today-Testing: If you were able to join the call sponsored by Nebraska ICAP today you had an opportunity to hear about testing from some facilities that have already done some testing. The call may have answered some of your questions and raised more, but the recording of the call is a good resource. If you are interested in listening to the call, here is the link to the recording. If you have questions about the information, Dr. Ashraf will join us for the LAN Member call at 11:00. Information below.

9/3/20: Assorted Testing Q&A from NE DHHS: How often is testing information required to be reported to NE DHHS?

All tests must be reported as soon as possible; same day reporting is preferred.
Submit test results once a day with a summary of all results obtained since the last time the report was submitted (the previous day).
IF testing was done AFTER the daily report was submittedi, nclude those results on the next day's report.

Is the "Tests performed in a lab" tab the right place to report results from the Point of Care equipment?

No, use the 'Test NOT Performed in a Lab' tab in the Excel spreadsheet.
The 'Tests performed in a Lab' is only for laboratories use and contains additional data requirements specific to a Laboratory.

If the facility uses TestNebraska or contracts with a private lab, are these results reported on the "Tests performed in a lab" or "Tests performed NOT in a lab"?

All tests sent to a private Laboratory are reported to DHHS by that Lab and do NOT need to be reported by the LTC facility.

If the facility uses one of the newer approved antigen tests that does not require equipment or a CLIA waiver, for example the Abbott test, where do these results get reported?

Facilities are only required to report COVID-19 testing that their staff performs using a Point of Care testing device.
Report these tests using the 'Test NOT Performed in a Lab' tab on the Excel spreadsheet.
ALL tests done by LTC staff suing a Point of Care testing device must be reported.
- Report tests on both Staff AND Residents
- Report both Negative AND Positive tests

9/3/20: SNF Infection Control Distribution Incentive Payments Announced: The HHS announcement did not include specifics on how measures would be calculated, but to qualify:

Must be a nursing home or skilled nursing facilities with active state certification
Must receive reimbursement from CMS (Medicare/Medicaid)
Must be in good standing (no revocation, terminations, expirations of certification or enrollment)
Must report to at least one of these three data sources: CASPER, Nursing Home Compare or Provider of Services (POS)

The two measures will be:

Ability to keep new COVID infection rates low among residents
Ability to keep COVID mortality low among residents. (we are told this measure will be more lightly weighted than the prior measure and will be risk adjusted).

There will be four monthly performance periods in September, October, November, December. $500 million per performance period/month will be distributed in the form of incentive payments to eligible nursing homes in October, November, December of 2020 and January 2021.

HHS will compare CDC county-level data related to total confirmed/suspected COVID 19 infections and test positivity rates to nursing home NHSN LTCF COVID-19 reported data on COVID infection and mortality rates. There are no further details regarding the formulas or specific calculations to be used at this time.

9/3/20: NASEM Vaccine Allocation Comments: LeadingAge is submitting comments to NASEM on its draft framework for COVID-19 vaccine allocation. Key priorities include supporting phase 1 status for front line workers, including aging services and older adults in congregate settings. We are asking NASEM to define the second item broadly and specifically include people living in IL, affordable housing, and community-based services in the final framework. Comments are due tomorrow by midnight Eastern time. Comments can be submitted here: https://www.nap.edu/vaccine/. Note there is a 5,000 character limit including spaces.

9/3/20: New "Care Compare" Site: Many months ago CMS announced they were going to merge all of the "Compare" sites into one and LeadingAge participated in the stakeholder engagement sessions for this project. It was scheduled to launch in the spring. Today, CMS released this announcement about the new CMS Care Compare site. Access the new site here. The old compare sites (Nursing Home Compare, Home Health Compare, Hospice Compare) are all still live with a banner at the top of each one encouraging consumers to try the new site. There is no information about when the traditional sites will sunset. The information that is displayed on Care Compare has not changed from what was displayed on the previous compare sites. The information has been consolidated under one interface with an updated look. However, the press release (linked above) seems to indicate that additional information, like cost or new quality measures, may be included in the future.

9/3/20: Updated COVID-19 Infection Control Survey Tool and Checklist: With the implementation of the new testing requirements, CMS updated the COVID-19 Infection Control Focused Survey tool. LeadingAge has completed updates on the LA supplemental survey tool and checklist and it is again available on the COVID-19 nursing homes page. You can access the updated tool, which includes the updated CMS tool, here.

9/3/20: PPE Opportunity In the next few weeks it appears that we will have some SMALL and MEDIUM VINYL gloves available to LeadingAge Nebraska members. If you are in need of these items, please email me (jenifer.acierno@leadingagene.org) to let me know. Please indicated how many VINYL gloves in SMALL and MEDIUM sizes that you NEED. These are meant to meet the need for members that are unable to secure VINYL gloves otherwise.

9/3/20: Member Weekly Update Call COVID-19 weekly member connections via Zoom on Fridays at 11:00 a.m. CT. As schedules permit, Special Guests Governor Pete Ricketts, Dr. Gary Anthone, and Dr. Salman Ashraf will also participate and provide state updates on the virus. Time will be allotted for discussion and questions.

Join via Zoom: https://zoom.us/j/291925920 | Or call: (346) 248-7799 Webinar ID: 291 925 920

9/2/20: Provider Relief Funds Application Process NOW Open to Private Pay AL and Nursing Homes: We are pleased to be able to share this information for our Assisted Living and some additional Nursing Homes. Private pay members can now access some provider relief funds. Last night around 7 PM Eastern time, HHS announced that it was taking applications for assisted living facilities to receive Provider Relief Funds. The announcement detailed that HHS is inviting applications for provider relief funds that may have been previously ineligible for Phase 2 General Distribution funds. ALFs will receive 2% of their annual revenue from resident care. Additional details are available on the Provider Relief Website. Providers will have until September 13 to begin the process by entering their Tax Identification Number (TIN) for validation. More analysis coming tomorrow.

LeadingAge has outlined the details on the AL application process in an article posted today on the LeadingAge website. What isn't in the announcement but we have been told by HHS is that PRIVATE PAY NURSING HOMES can also apply through this same process. HHS staff indicate this is an option. In the event that a private pay nursing home applies but is told that their Tax Identification Number is not valid, please contact me so that I can share with LeadingAge national. If you are an AL connected to an NF with a separate Tax ID Number, you are likely eligible for these funds.

9/2/20: CMS Nursing Home Training: LeadingAge shared that on their call today with CDC that CMS has received a great deal of feedback on the new training that was released last week. Some of the information is being interpreted in a way that is not consistent with CDC guidance. For this reason, CMS is reviewing the training and may make revisions in the future. More to come on this. Keep in mind until then that any recommendations for infection control are intended to be consistent with CDC guidance.

9/2/20: SNF Infection Control Distribution and Training: During the LeadingAge member update call today, it was indicated that at this point the $2B in performance payments that will be distributed will not be tied to nursing homes completing infection control training. There was an indication that a minimal amount of compensation will be available for those who voluntarily participate in the AHRQ Project ECHO training program, as Dr. Ashraf had mentioned in last week's ICAP call. If you are interested in more information about the potential of Project ECHO being available in Nebraska, please feel free to contact Sarah Stream, Infection Preventionist with the ICAP team.

9/2/20: HUD Announces Service Coordinator COVID-19 Payments:

Applications due to HUD by 9/11 Today, HUD announced that CARES Act awards for grant-funded Service Coordinators are now available. The supplemental payments will be approximately 9% of operating budgets, and applications for the payments are due to HUD by 9/11/20. LeadingAge will host a call with HUD staff next week to answer member questions. More information about the call and detailed instructions to apply for the payments, is available here: https://leadingage.org/regulation/hud-announces-service-coordinator-covid-19-payments
Grant Awards: The supplemental awards will be equivalent to 9% of their SCMF/CHSP FY2020 program operating budget.
Eligible Period of Increased Costs: March 27 - December 31, 2020
Application Deadline: 9/11/2020
Acceptance of Notice of Award: The authorizing official must access GrantSolutions and accept the award no later than 5 business days after receipt of notification. GrantSolutions is sending notification emails to eligible grantees.
Spending Plan will be due: Grantees must submit a spending plan via Grant Notes/Application to the assigned grant specialist within 20 days after acceptance of the award.
Availability of Funds: Once the spending plan is approved by the grants specialist, the funds will be available within 3 business days.Weekly Connection with Connie Vogt with LAN Members- Call from Today
We heard a great deal of information on testing during our call with DHHS and through email communications related to testing throughout the day, but there are still many questions outstanding. I have included the handouts and PowerPoint from today's call below. These handouts are also available on the LeadingAge Nebraska website at leadingagene.org, COVID-19 resources.
PowerPoint | QSO 20-28-NF Revised 7/9 | QSO 20-28-NH Revised 7/20 | QSO 20-38-NH | NH COVID DATA FAQ | COVID Testing FAQ SNF
The main points from the call that are included in the PowerPoint address reopening to visitors, clarifications on communal dining and activities, testing and reporting. As was indicated last evening, the testing requirements DO NOT apply to Assisted Living yet. The requirements DO apply to Nursing Facilities, testing requirements and associated reporting went live today when the rule was published. Connie indicated that the key to addressing any challenges that you encounter while trying to comply is to document EVERYTHING. Please see the email from Becky Wisell that went to all NF providers around 4:00 this evening for more information on how to handle reporting at the State level.

9/2/20: Federal Eviction Moratorium: On September 1st, the CDC announced an "exceedingly rare" order to temporarily halt evictions for people impacted by COVID-19 through the end of the year. Housing providers, including HUD-assisted senior housing, are prohibited from evicting residents under a certain income threshold for non-payment of rent until December 31st; rent payments are still due, and housing providers can still charge late fees. LeadingAge will be working with federal agencies to provide accompanying relief for housing providers. For more information about the Agency Order and to read a recent LeadingAge letter to the CDC on evictions, click here.

9/2/20: Links for Connie Vogt Call Wednesday, 9/2/20:

9/1/20: Clarifications for LeadingAge Member From HHS on Antigen Testing Machines: LeadingAge policy staff met with Rachel Kellogg, Deputy Chief of Staff to Assistant Secretary for Health Brett Giroir to discuss questions on antigen testing and the BD and Quidel machines. Here are some key take aways from the call:

Providers that have not received an antigen testing machine (or an adequate supply of test kits) by the time the CMS interim final rule is published and takes effect should be documenting and informing local and state health officials.
Test kits are specific to the BD and Quidel machines. BD test kits cannot be used on the Quidel machine and vice versa.
Though BD machines are less accurate than Quidel's, BD is a larger company with more production capacity, so more of these are being distributed.
Both companies have set up dedicated websites to respond to nursing home requests for test kits. The links are at https://www.bdveritor.com/ and https://togetheragain.quidel.com/.
If machines arrive broken or damaged or with a clearly erroneous number of test kits, providers can contact the companies directly. If a provider doesn't receive a machine at all or there are other unusual issues, please let me know and I can pass them on to LeadingAge national to be shared with Assistant Secretary Giroir's office.
HHS will soon issue its allocation plan for the 150 million rapid result Abbott tests. If nursing homes have these tests, they may use them in lieu of or in combination with the antigen machines and PCR tests. Recall, the interim final rule requires testing but it doesn't explicitly require use of the antigen machine.

9/1/20: Nursing Home Testing Rule: The LeadingAge analysis of the testing rule can be found here, it includes updates that have rolled out since the original analysis was posted.

Many of you have been asking about the effective date of the rule. The rule is scheduled to be published to the Federal Register on September 2. It will be effective on September 2.

CMS posted the county positivity rate data last Thursday. It can be accessed through a link here under "COVID-19 Testing". This website is generally updated on Thursdays. We will get more info from CMS to determine how often the county positivity rate file will be updated.

9/1/20: Point-of-Care Testing: We have been fielding a lot of questions about the point-of-care testing devices and the HHS initiative to send them out to nursing homes by September 30. LeadingAge has created this tool to act as a quick reference for the most common questions. The tool will continue to be updated as new questions arise and information changes.

9/1/20: NHSN updates: NHSN has updated the COVID-19 module for long-term care. Updates include 4 new data elements to collect information on point-of-care antigen testing. The Table of Instructions and CSV templates for group reporting have also been updated and can be accessed here under "Data Collection Forms & Instructions" and "Group Resources". CDC will host 2 webinars next week to review these changes: September 1 at 1:00pm ET and September 3 at 1:00pm ET. Register here under "Upcoming Trainings".

9/1/20: Change to Availability of Employee Test Results: Reminder...the question had arisen over the past many months as to whether employee testing results from TestNE could be shared directly to facility emails versus having each staff having to check for results and report back from their individual emails. In a call with DHHS this morning, they shared that facilities CAN have employee testing reported directly to a facility email address, however, the facility must have a signed release from the employee indicating that they consent to sharing the testing with the facility AND the release must be kept on file.

9/1/20: PPE Opportunity: We have the potential to assist in securing VINYL gloves in sizes SMALL and MEDIUM for our members. If this is something that you would be interested in, please email me (jenifer.acierno@leadingagene.org) to let me know that you are interested and how many VINYL gloves in SMALL and MEDIUM sizes you NEED. These are meant to meet the need for members that are unable to secure VINYL gloves otherwise.

8/28/20: Nursing Facilities Receive Deposits from HHS: Beginning yesterday, roughly $2.5 billion arrives in SNF Bank Accounts today.

Medicare and Medicaid certified nursing homes began receiving Provider Relief Fund payments August 27 that total roughly $2.5 billion. This is the initial payment from the $5 billion distribution to nursing homes announced in late July. HHS issued its announcement on the funds around 10 a.m. CT, which also highlighted two voluntary training resources being made available to nursing homes in their fight against COVID-19.

The formula is that each nursing home with 6 beds or more received $10,000 base amount plus $1,450 for each bed. There is no indication that providers are required to participate in either of the two training programs it has made available and references in the announcement. However, providers who choose to participate in The AHRQ National Nursing Home COVID Action Network which is based on the Project ECHO pilot will be eligible for some compensation to cover staff training time. Dr. Ashraf with Nebraska's ICAP is working to try to bring one of the Project ECHO learning hubs to Nebraska. If you are interested in receiving more information on this, please reach out to Sarah Stream, Infection Preventionist with ICAP at sstream@nebraskamed.com.

It remains unclear whether the use of the funds that have been distributed will be limited "to support facilities' COVID-19 infection control efforts, including by conducting appropriate testing, acquiring necessary personal protective equipment (PPE), investing in staff and establishing COVID-19 isolation facilities" as noted in a communication that went directly to providers. There was was no new information on the timing or details surrounding the $2 billion performance incentive payments except that more to come later this fall.

LeadingAge prepared the following article summarizing and analyzing this development.

8/28/20: CMS Guidance Explainer: LeadingAge has prepared this article explaining the CMS guidance about nursing home testing that came out Wednesday.

8/28/20: Change to Availability of Employee Test Results: The question had arisen over the past many months as to whether employee testing results from TestNE could be shared directly to facility emails versus having each staff having to check for results and report back from their individual emails. In a call with DHHS this morning, they shared that facilities CAN have employee testing reported directly to a facility email address, however, the facility must have a signed release from the employee indicating that they consent to sharing the testing with the facility AND the release must be kept on file.

8/26/20: Breaking News...CMS Releases Testing Memos: This afternoon, CMS released 2 new QSO memoranda related to COVID-19 testing for LTC providers. QSO-20-38-NH provides detailed guidance on the mandatory testing requirements for LTC providers for residents and staff and revises the COVID-19 Focused Infection Control Survey tool. The Interim Final Rule released yesterday provided the authority for CMS to mandate testing parameters for all Medicare and Medicaid certified SNF/NF providers across the country. CMS also released QSO-20-37-CLIA,NH, which sets the standards for reporting COVID-19 test results related to yesterday's Interim Final Rule.

LeadingAge analysis of the guidance will be available soon. The guidance relies heavily on CDC guidance, so certain parts of implementation may not be much different that what nursing homes are already doing. The biggest requirement, testing staff according to county prevalence, will be challenging. This will include:

Monthly testing in counties with less than 5% positivity
Weekly testing in counties with 5-10% positivity
Bi-weekly testing in counties with greater than 10% positivity

Positivity rates should be monitored every other week here (the data will be available beginning August 28). Nursing homes have the flexibility to choose whether this testing is conducted via point-of-care antigen tests or nucleic tests processed in an off-site lab (PCR testing), provided test results are returned within 48 hours. The guidance also spells out how to respond to residents and staff who refuse testing, and exactly what documentation is required for many situations, such as outbreaks, symptoms, testing residents, testing staff, refusals, lack of access to testing, and more. The COVID-19 Focused Survey Tool has been updated to reflect these changes.

8/26/20: COVID-19 Nursing Home Training: Check out this LeadingAge article related to the new COVID-19 training that CMS announced yesterday. There is no indication at this time that this training is linked to Provider Relief Funding, but we are waiting to hear more. The training is available online and has 15 modules targeted to front-line staff and nursing home management.

8/26/20: 3-day Stay Waiver STILL IN EFFECT: Have you heard from a hospital that the 3-day stay waiver is no longer in effect or will be terminated soon? WRONG. LeadingAge has confirmed with CMS twice in the past week that the waiver is in fact still in effect.

8/26/20: NHSN Updates: NHSN updates are scheduled for tomorrow. Point-of-care antigen testing data will start being collected. CSV templates will be updated ahead of or along with the NHSN module. Those who are responsible for group reporting should check the NHSN site for updated templates. NHSN will also be working to transition all users to enhanced security levels within the next 2 months. This is optional and users will be contacted by NHSN in the coming weeks with information on how they can take part. Required reporting will not be interrupted while a user transitions to the upgraded enrollment.

Questions? You can always visit the LeadingAge national main coronavirus page, or contact your state association at jenifer.acierno@leadingagene.org.

8/26/20: Links for today's call with Connie Vogt:

8/25/20: *Special Update from CMS Call Today*

8/25/20: CMS Stakeholder Update Call: The CMS Stakeholder Update Call announced at 2:30 EST and held at 4:30 EST today was focused on the roll out of the interim final regulation on nursing home staff testing and CLIA reporting, but covered a range of other related topics of interest to nursing home providers. The call is summarized in this article.

8/25/20: CMS releases Interim Final Rule with Comments on staff testing, CLIA reporting: This afternoon CMS issued the rule it announced in July would be coming soon, mandating staff testing and CLIA reporting for nursing homes that test. Here is an article summarizing the highlights that will be important for LeadingAge members. Effective immediately, nursing homes that fail to comply with requirements to report COVID-19 data to CDC through NHSN will be subject to

Citation at the scope of widespread and severity of no actual harm with potential for more than minimal harm that is not immediate jeopardy (level "F").
Enforcement of a CMP of $1,000 per noncompliance, and
Increasing increments of $500 per CMP for up to 12 instances of noncompliance.

As outlined previously in CMS guidance, nursing homes that fail to report on a weekly basis will receive a $1,000 CMP that increases incrementally by $500 for each subsequent missed week of reporting. This will cap at 12 weeks ($6,500) due to pre-existing statutory caps.

8/25/20: New Infection Control Training: CMS announced today a new infection control training available to nursing homes: "CMS Targeted COVID-19 Training for Frontline Nursing Home Staff and Management". Read the announcement here. This training is designed for both front-line staff and nursing home management, with separate training modules for each (5 for front-line staff, 10 for management). This self-paced training is available immediately on the CMS Quality, Safety & Education portal and certificates of completion will be available for each course completed. Additionally, subject matter experts from CMS and CDC will be available through bi-weekly webinars beginning this Thursday, August 27 and running through January 7. Members can register for these webinars here.

8/25/20: PPE Updates: The call today provided details on N95 mask production in the United States, which has increased from 30 million per month pre-Covid to 100 million per month now and projected to become 160 million per month. The federal government is going to ship 1.5 million N95 masks in the next week to nursing homes that indicated low supplies in the NHSN survey data. LeadingAge Nebraska has reached out to the Governor's office about who will be receiving the masks, as apparently Governors across the country received the list of providers who would receive shipments in their state.

During August and September, 14 million N95 masks will be deferred from the national stockpile, and sent to targeted markets in the commercial marketplace including hospitals, nursing homes, dentists, first responders in an attempt to provide additional commercial volume. It was noted that "we are fundamentally in a different place than we were back in March or April". The country now has 120,000 ventilators to deploy and states have 30-60 days of PPE supply on hand.

8/25/20: POC Testing: During the call today it was reported that 5593 nursing facilities have already received antigen testing machines and that by the end of September all nursing homes with CLIA waivers (about 14,800) will have the machines. He added that over two million test kits had also been shipped, enough to test each staff members at least twice and that nursing homes would be able to order additional tests (no details provided on that).

8/25/20: FDA recommendations for diagnostic tests for screening asymptomatic individuals for COVID-19: An FDA FAQ recommended that health care providers screening asymptomatic individuals should consider using a highly sensitive test, especially if rapid turnaround times are available. If highly sensitive tests aren't available or turnaround times are slow, providers should use less sensitive point-of-care tests, even if they aren't specifically authorized for this indication (commonly referred to as "off label"). "For congregate care settings, like nursing homes or similar settings, repeated use of rapid point-of-care testing may be superior for overall infection control compared with less frequent, highly sensitive tests with prolonged turnaround times." Negative tests results should be considered in the context of clinical observations, patient history and infection rates in the location or surrounding community and, if indicated, should be followed with a PCR test. "It is not necessary to perform confirmatory high-sensitivity tests on individuals with negative antigen test or other point-of-care test results if they are obtained during routine screening or surveillance."

8/25/20: Provider Relief: On today's call, Seema Verma said there would be $2.5 billion for "testing in nursing homes." She alluded to the possibility that the funds may start being distributed yet this week. The formula will include a base payment per facility plus additional funds based on the number of beds.

8/25/20: SNF VBP Performance Period Changes for FY2022: The SNF Value-Based Payment program for FY2022 would normally be based upon readmission measure performance between October 1, 2019 and September 30, 2020. However, under the public health emergency, CMS granted an Extraordinary Circumstances Exceptions to reduce reporting burden for the SNF VBP reporting requirements for January 1 through June 30, 2020. Therefore, under the interim final rule, CMS is changing the performance period for the SNF VBP program for FY2022 to include data from April 1, 2019 - December 31, 2019 plus July 1 through September 30, 2020. This provides a full 12 months of data for the calculations. Keep in mind, the SNF VBP program uses claims data so there is nothing new for SNFs to report.

8/26/20: LeadingAge 3:30 Coronavirus Update Call, Wednesday, August 26: Is in-person indoor visiting a possibility in your state or will it be sometime soon? Join us for our Coronavirus Call on Wednesday, August 26, at 3:30pm Eastern time and hear from LeadingAge member Brian King, who leads the health and wellness programs at Deerfield retirement community in Asheville, North Carolina. Brian will provide great insight on how his community was able to overcome positive COVID-19 cases to work with the state to allow in-person visitation for residents. Through a vigorous testing program and working with staff to eliminate small risks, they have been able to safely open up and allow in-person visits even with positive cases in the community. Brian will also discuss his communities communication efforts with families and staff and how they are overcoming apathy and encouraging staff to stay vigilant outside of work to protect residents. If you aren't already registered, sign up for calls here.

8/24/20: Nebraska Testing Equipment Assignment & Delivery Information: Here is the most recent information related to testing equipment and delivery timing. Look HERE for the listing of facilities in Nebraska, which testing equipment (Quidel or DB) that you they will be receiving, and the anticipated time frame for receipt. The delivery dates are somewhat dynamic, according to CDC, but will likely continue through the end of September.

We would encourage you to get ready and informed about reporting until then. If you are a CLIA waived organization and you do COVID testing, you must report under HHS lab reporting guidelines in addition to NHSN reporting. This reporting requirement is not new. CMS addresses it in this FAQ. It is also included in this Q&A developed by LeadingAge.

From the CMS FAQs:

-Are nursing homes required to report results of any COVID-19 tests?

-Yes. All laboratories must have a CLIA Certificate and report the results of the COVID-19 tests that they conduct to the appropriate federal, state, or local public health agencies. Laboratories must report data for all testing completed, for each individual tested. This data must be reported within 24 hours of test completion, on a daily basis, to the appropriate state or local public health department, based on the individual's residence. Testing sites must report all diagnostic test data in accordance with the HHS Lab Data Reporting Guidance for COVID-19 issued June 4, 2020 and meet these reporting requirements by August 1, including providing your facility name and CLIA number when reporting results. For more information on reporting requirements, you can visit the CDC website.

8/24/20: Information on Training and Availability of Additional Testing Supplies from McKesson: Below is the link and the information on the BD analyzer training that will take place this week on Wednesday 8/26 and below that is a hyperlink to the training on the Quidel unit that was held a couple of weeks ago. We will make the recording of the BD analyzer training available after the webinar this week.

Are you ready for COVID-19 testing at your facility? Understanding the HHS program and the BD Veritor™ System

Date: August 26, 2020 | Time 2:00 PM CST

Save my seat!

View Playback Recording Quidel Analyzer training recording.

8/24/20: NHSN Security Enhancement: Remember how CDC had to stand up the NHSN COVID-19 reporting module for nursing homes extremely quickly, which left people scrambling to navigate an incredibly frustrating "expedited" enrollment process? Well, get ready. NHSN is hoping to upgrade all providers reporting through NHSN to the fully-secure enrollment, which requires the SAMS grid card within the next 2 months. NHSN has already launched a pilot initiative, working with 250 nursing homes over the past 2 weeks and successfully upgrading enrollment for 50 of them. The reason for this change is because currently, nursing homes are reporting only facility-level data but soon, nursing homes will begin reporting patient-level data, such as individual test results. Here's what you should be aware of:

At this time, this enrollment upgrade is OPTIONAL.
Even if providers want to upgrade, they do not need to proactively initiate an enrollment upgrade at this time.
NHSN (CDC) will send out guidance to all reporting providers with instructions on how to start the process. They plan to share this info with the QIOs and with LeadingAge to allow us to help members through this process.
Ability to report through NHSN will not be impacted during the upgrade process. Members will still be able to report according to CMS requirements even as they work to complete their enrollment upgrade.

8/24/20: NHSN COVID-19 Module Update: The NHSN COVID-19 reporting module for long-term care is scheduled to be updated this coming Thursday. Updates will include new questions about access to and use of point-of-care antigen testing, as well as clarifications in the Tables of Instructions related to reinfection and false positives. Those "soft alerts" that pop up any time a provider reports more than once in a week will also go away. The CSV templates for group reporting will be updated on or before Thursday and they hope to send out an alert to group users ahead of Thursday's updates, but the ability to do this depends on how quickly that communication gets through internal clearance. A version 2 of the FAQs document is anticipated by the end of August.

8/24/20: 3-Day Stay and Benefit Period Waiver: There have been a lot of questions about the qualifying hospital stay (3-day stay) and the benefit period waivers over the past few months. Both waivers are still in effect, both refer to skilled nursing facility services under your Medicare A benefits, but one requires direct impact from COVID-19 and for the other, the impact is assumed and applicable for all. LeadingAge has created this EXPLAINER to help.

8/24/20: Medicaid Information Bulletin from CMS: This afternoon CMS issued an Informational Bulletin on Medicaid Reimbursement Strategies to Prevent the Spread of COVID-19 in Nursing Facilities. The bulletin is a consolidation of already existing information. CMS reminds states that they have options to obtain an expedited State Plan Amendment under the Medicaid Disaster Relief SPAs. Once approved the state can increase payments to nursing homes or just certain nursing homes treating COVID diagnosed residents or in outbreak areas. There is no additional funding provided for this effort, however, we continue to advocate with DHHS for an increase in COVID-19 related nursing facility rates.

8/24/20: HHS Telehealth for Community-Based Organizations: On August 26th, from 1-2 CST, HUD and HHS will host the next webinar of its Telehealth for Community-Based Organizations series, titled Promising Practices: Accessibility and Language Access. The webinar will focus on telehealth accessibility for individuals with access and functional needs, as well as individuals with limited English proficiency. The program will highlights innovative strategies for ensuring access to older adults, people with disabilities, and addressing cultural and linguistic competency when providing telehealth services; there will also be an opportunity for questions and answers. Click HERE to register.

8/24/20: Rescheduled Member Connection with Connie Vogt: The August call with Connie Vogt was cancelled and the next call was not scheduled until September. Connie has kindly agreed to reschedule the August call to next Wednesday, August 26, 2020 from 10:00-11:00 CT. Please join us then.

Join Zoom Meeting: https://nehca-org.zoom.us/j/92253640474; Meeting ID: 922 5364 0474; Or call: 312-626-6799

8/19/20: Rescheduled Member Connection with Connie Vogt: The August call with Connie Vogt was cancelled and the next call was not scheduled until September. Connie has kindly agreed to reschedule the August call to next Wednesday, August 26, 2020 from 10:00-11:00 CT. Please join us then.

Join Zoom Meeting: https://nehca-org.zoom.us/j/92253640474 Meeting ID: 922 5364 0474, or call: 312-626-6799, Meeting ID: 922 5364 0474

8/19/20: CMS Resumes Survey Activity: As was included in Monday's update, CMS announced on August 17 that they will resume survey and enforcement activity, including standard surveys, revisits, and complaints triaged from non-IJ medium up through IJ. As a part of the announcement, CMS indicated that they will direct state survey agencies to resume routine inspections of all Medicare and Medicaid certified providers and suppliers and resolve enforcement cases that were suspended on March 23, 2020 in QSO-20-20-ALL. CMS has expanded the ability for state agencies to clear plans of correction through desk review and instructs survey agencies to resume on-site activity as soon as they have adequate staff and PPE to do so. The details of the changes were published in QSO-20-35-ALL, which is effective immediately. See the LeadingAge analysis available here.

8/19/20: CDC Released New Guidance on Antigen Testing: This week CDC issued new guidance on antigen testing that applies generally to providers using rapid antigen testing. There is an expectation that guidance specific to long-term care facilities will be released as well. The new guidance acknowledges that rapid antigen testing is not as accurate as PCR testing, but asserts that the testing is useful and proper interpretation of results is critical. Antigen tests are most helpful when viral load is highest, generally within the first five days of infection. CDC asserts that antigen tests are useful in cases of known exposure or high risk congregate settings when repeat testing can help to quickly identify infections and inform infection control procedures. Clinical presentation and prevalence of infection in the community will likely be used to determine the need for PCR testing. More information to come as it is available.

8/19/20: Need for Eviction Protection: Today LeadingAge sent a letter to several federal agencies urging quick action in support of low-income residents and housing providers impacted by the current crisis. The recent executive order did not include an extension of the eviction moratorium and left it up to federal agencies to determine the role of preventing evictions in containing COVID-19. LeadingAge sent a letter to the agencies addressed in the executive order asking for the CDC to urgently clarify the importance of housing stability during the pandemic. The letter also asks HUD to immediately issue eviction protections and requests financial support for housing providers. The letter builds on the LeadingAge statement released yesterday, together with several other major housing organizations, asking Congress and the Administration to provide meaningful support for impacted housing communities.

8/19/20: ACTION ALERT: JOIN US! COVID-19 isn't taking a summer recess, neither should Congress. Tell them to finish the job and #Act4OlderAdults! https://actnow.io/ZjwIIVA

8/19/20: PPE Opportunity with Laguna Scientific: Still having difficulty ordering and securing PPE? Through our relationship with one of our PPE partners, you have the option to use the supplier, Laguna Scientific, to order PPE directly. Laguna Scientific is out of California and they have been really good to work with and quick with delivery. If you are interested in any of the Personal Protection items on their website you can email Subbarao at info@lagunascientific.org with information on what you would like to order and please cc: jenifer.acierno@leadingagene.org. In your email let Subbarao know that you are a LeadingAge Nebraska member. He will use that information to facilitate getting our members as reduced of a cost as possible for the items needed. If you have questions about this feel free to contact Jenifer.

8/17/20: CMS Memo Expands Survey Activity: CMS released a memo this evening announcing expansion of survey and enforcements for all CMS-certified providers and suppliers. This builds on the survey activity as announced previously in the reopening guidance and in a June 1 memo.

Expanded activity now includes complaints assessed at non-IJ medium, annual recertification, and mandatory revisits for surveys on or after June 1. CMS has expanded the desk review policy and issued guidance on resolving enforcements that were previously suspended (Denials of Payment for New Admission and CMPs). CMS directs that on-site survey activity resume as soon as resources permit (staff, PPE). More information will be provided as it becomes available.

8/17/20: Nebraska Specific Survey Deficiency Information for NF & AL: Listed below are the top 10 deficiencies for nursing home E-tags and F-tags. Following that are the top 10 deficiencies for ALFs. This includes information for 2020. As survey activity looks to increase in the future, these lists may provide some areas to focus on.

Top 10 E-tags and F-tags for Nursing Homes

Emergency Preparedness (1.02)

E0041 - Hospital CAH and LTC Emergency Power
E0004 - Develop EP Plan, Review and Update Annually
E0024 - Policies/Procedures-Volunteers and Staffing
E0039 - EP Testing Requirements
E0013 - Development of EP Policies and Procedures
E0001 - Establishment of the Emergency Program (EP)
E0006 - Plan Based on All Hazards Risk Assessment
E0009 - Local, State, Tribal Collaboration Process
E0015 - Subsistence Needs for Staff and Patients
E0023 - Policies/Procedures for Medical Documentation

F-Tags Long Term Care Facilities

0880 - Infection Prevention & Control
0689 - Free of Accident Hazards/Supervision/Devices
0884 - Reporting - National Health Safety Network
0812 - Food Procurement,Store/Prepare/Serve-Sanitary
0609 - Reporting of Alleged Violations
0657 - Care Plan Timing and Revision
0761 - Label/Store Drugs and Biologicals
0684 - Quality of Care
0656 - Develop/Implement Comprehensive Care Plan
0725 - Sufficient Nursing Staff

Top ALF Deficiencies: N-Tags

0230 - Non Licensed Health Care Professional
0250 - Evidence Meeting Resident's Needs
0227 - Administration of Medication
0206 - Direct Care Staff Orientation
0239 - Storage
0248 - Food Safety
0278 - Environmental Safety
0201 - Administration
0207 - Ongoing Training
0222 - Provision of Medicine

8/17/20: LeadingAge Letter to Seema Verma: Following the information provided in last week's CMS Strike Team webinar, Katie Smith Sloan sent a letter to CMS Administrator, Seema Verma, outlining concerns and seeking an opportunity to discuss them. The letter stated that all members appreciate the review of infection control basics, but would hope to hear more complex discussion when strike teams present their findings. There was also an ask for clarification about a few items that were contradictory to current policy, such as the comment that if nursing homes do not have an infection preventionist they should build relationships with one in the community (they are required to have one); and that staff need a negative test before returning to work (inconsistent with CDC guidance). More information will be provided as it becomes available.

8/17/20: Provider Relief Fund Reporting Information Delayed: HHS announced that it will not be providing additional details about the reporting process this week as was planned. HRSA is continuing to refine its data elements and will provide those additional details at a later date. It is anticipated that the reporting instructions and data collection template will be provided in advance of when providers will need to submit their data into the reporting system. The current target date for submission is October 1, 2020.

8/17/20: Medicare Care Compare Webinar: CMS is making changes to help people with Medicare find information about health care providers and services, as part of the eMedicare initiative to modernize and personalize experiences with Medicare information. Care Compare on Medicare.gov standardizes 8 existing compare sites to offer a more streamlined compare experience for users.

There will be a webinar on August 24th from 2-2:45pm ET that will preview Care Compare to give partners an opportunity to learn about it before CMS launches it on Medicare.gov. While this is a preview, CMS will continue to make improvements based on ongoing feedback. To register for this webinar, visit CMSnationaltrainingprogram.cms.gov/moodle/course/view.php?id=91. Space is limited.

8/17/20: From McKnight's: Emergency funding, staffing have been key factors for provider's survival during COVID-19: Long-term care providers across the country have detailed numerous ways how the pandemic has drastically and negatively impacted their operations since the virus first emerged in early March. Read more HERE.

See this great infographic developed by LeadingAge that demonstrates the need for testing and related challenges.

8/17/20: Governor Ricketts signs LB 1053: On Saturday, Governor Ricketts signed LB 1053, which requires the nursing home Medicaid rate methodology be included in regulation. The bill was a priority for the Health and Human Services Committee after DHHS removed the rate methodology from the regulations with an update this summer. Thanks to each of you who took time to reach out the your elected officials to advocate for this bill and thanks to Kent Rogert for his work advocating on behalf of LeadingAge Nebraska members.

8/17/20: PPE Opportunity with Laguna Scientific: Still having difficulty ordering and securing PPE? Through our relationship with DonatePPE.org, we have an option to use one of their suppliers for our members to order PPE directly. The name of the supplier is Laguna Scientific and they are out of California. They have been really good to work with and quick with delivery. If you are interested in any of the Personal Protection items on their website you can email Subbarao with information on what you would like to order and please cc: jenifer.acierno@leadingagene.org. In your email to Subbarao (info@lagunascientific.com) let him know that you are a LeadingAge Nebraska member. He will use that information to facilitate getting our members as reduced of a cost as possible for the items needed. If you have questions about this feel free to contact Jenifer.

8/12/20: Provider Relief Fund Updates: As of today HHS has indicated that they have NOT finalized how they will be distributing these funds to nursing homes. In regard to the next $5B Nursing Home Distribution, $2.5 billion will go out as an initial payment, but HHS is unsure which factors will be used to determine how much a nursing home receives. The same applies to the additional performance-based payment incentives. More information will be shared as it becomes available.

The Provider Relief Fund Application Process is open for Medicaid and many Medicare providers. HHS is referring to Phase I of General Distribution as the payments that went to Medicare providers in April. Phase II - General Distribution is what is happening right now through the application process. HHS updated their FAQs with new information including an expanded list of who is eligible to apply for the Phase II funds. As was indicated on Monday:

Medicare providers who missed the June 3 deadline to apply for second payment by submitting their federal tax return and revenue loss information.
Medicare providers who've experienced a Change in Ownership in 2019 or 2020 under Medicare Part A & received no Medicare FFS in 2019.
Medicare providers whose total General Distribution payments are not equal to 2% of their annual patient service revenue. NEW
Medicare providers who previously rejected General Distribution payments and want to reapply. NEW

HHS noted in their FAQs that providers who are part of organizations that received a Phase I - General Distribution payment are no longer prohibited from applying for funds under Phase II, which opens the door for some Medicaid providers who have not yet seen provider relief fund dollars to apply. All providers who seek funds under Phase II must apply through the Provider Relief Fund Application and Attestation portal by August 28.

HHS is hosting another webinar this Thursday, August 13 at 3p ET on the application process for both Medicare and Medicaid providers. Providers must register.

8/12/20: REMINDER- PBJ Staffing Data Submissions: DUE by Friday, August 14

Important reminder for nursing home - PBJ staffing data submissions are due by this Friday, August 14. PBJ data submissions were suspended under an 1135 waiver, but the waiver was terminated on June 25. Data for calendar quarter 2 must be submitted by Friday and will be updated in Nursing Home Compare on the next regularly scheduled update in October 2020. CMS is encouraging providers to submit data for calendar quarter 1, but that data is not required. See this article by LeadingAge for more information.

8/12/20: HHS Announces new Rural Health Model: HHS just announced something called the Community Health Access and Rural Transformation (CHART) model to build upon the President's Medicare Executive Order from last year and CMS's Rethinking Rural Health Initiative. For more information see this CHART fact sheet.

8/12/20: Updates to NHSN COVID-19 module for LTCF: CDC has updated the testing data elements on the NHSN COVID-19 reporting module. For more information on these changes, please see this article by LeadingAge.

8/12/20: National CMS/CDC Nursing Home COVID-19 Training Series Webcast: Coming next in the webcast series by CMS and CDC, and hosted by the QIO is Transparency: Resident and Family Notification, Department of Health and Other Notifications, is set for Thursday, August 13 from 4 to 5 pm ET. Register for this webcast and others in this series.

During this session, learn about:

Guidance and policies on transparency during the COVID-19 public health emergency
Best practices to implement a comprehensive communication plan
Insight from a COVID-19 family member
Strategies to provide compassionate care and communication during the COVID-19 pandemic

View recordings, slides, and resources on QIOProgram.org. CMS does not provide continuing education credit for participation in this series.

8/12/20: Nebraska Legislature Passes LB 1053: Yesterday the legislature passed LB 1053, which requires that the nursing home Medicaid rate methodology be included in regulation. The bill has been presented to the Governor for signature. DHHS removed the rate methodology from the regulations with an update this summer.

8/10/20: More Providers Eligible to Apply for Relief Funds: Over the weekend information came out regarding additional possibilities for provider relief. This afternoon some specifics have been made available. HHS has opened up the Provider Relief Funds application process to the following Medicare providers. Please note, there are some newly eligible providers:

Medicare providers who missed the June 3 deadline to apply for second payment by submitting their federal tax return and revenue loss information.
Medicare providers who've experienced a Change in Ownership in 2019 or 2020 under Medicare Part A & received no Medicare FFS in 2019.
Medicare providers whose total General Distribution payments are not equal to 2% of their annual patient service revenue. NEW
Medicare providers who previously rejected General Distribution payments and want to reapply. NEW

It should also be noted that providers who have low Medicare volumes and are predominantly Medicaid providers should also consider applying as they may not have received their full General Distribution payment (2% of annual patient service revenues) and they are not eligible to apply for the Medicaid Distribution. HHS has said that there should be parity between the Medicare General Distribution and Medicaid Distribution. In addition, we've learned that some members' cost reports do not report revenue from all patient service categories and so they, too, may not have received the full 2% of patient service revenue payment. This is their chance to have their payments reflect all payer sources' patient revenues.

HHS is hosting another webinar this Thursday, August 13 at 3p ET on the application process for both Medicare and Medicaid providers. Providers must register.

Providers have a deadline to submit information for validation by August 28 whether they are applying for Medicare General Distribution (HHS is referring to this as Phase I) or the Medicaid General Distribution (Phase II).

For the latest information on the Provider Relief Fund Program, visit: hhs.gov/providerrelief.

For the full press release, visit: https://www.hhs.gov/about/news/2020/08/10/hhs-provider-relief-fund-phase-2-general-distribution-now-accepting-additional-applicants.html.

8/10/20: Updates to NHSN COVID-19 module for LTCF: CDC has updated the testing data elements on the NHSN COVID-19 reporting module. These data elements are contained within the "Resident Impact and Facility Capacity" pathway. Previously, the data elements asked about access to testing. The data elements have been updated to specify types of tests (nucleic acid and antigen), and ask about barriers to testing. The data elements also ask about turn-around time for test results, whether or not facility-wide testing has been conducted over the past 2 weeks, and if so, why testing was conducted (symptom onset, in response to an outbreak, as part of surveillance, etc.). CDC says that this information will help improve understanding of barriers to testing. We also note that the PPE module was updated over the past few weeks to clarify that when responding to data elements about PPE supply, providers should consider conventional capacity. If providers have only contingency or crisis capacity supplies, they should be responding "no" to indicate that they do not have any supply of the selected PPE.

NHSN will be hosting another data quality webinar this Wednesday, August 12 at 1:00pm ET, to review these changes. Space is limited and registration is available on the NHSN COVID-19 LTCF module site.

8/10/20: HUD Announces Restart of Physical Inspections in October: On August 7th, HUD announced that the agency will resume Real Estate Assessment Center (REAC) inspections of HUD multifamily and public housing properties in early October. HUD had halted physical inspections on March 13th due to health concerns; the agency said it will utilize strict safety protocols to restart operations. According to the HUD press release, standard 14-day physical inspection notifications to owners will resume no earlier than September 21st, 2020, with the first inspections resuming on or about Monday, October 5th. Inspections will be prioritized based on a state or locality's COVID-19 rates, as well as on the property's previous scores. More information will be available here.

8/10/20: Congressional Update and White House Executive Actions (Memoranda): The President then issued several "Executive Orders" (formally "memoranda") responding to provisions that had expired and adding a temporary benefit for workers:

Memorandum on Authorizing the Other Needs Assistance Program for Major Disaster Declarations Related to Coronavirus Disease 2019: This order replaces the $600 per week extended unemployment benefits with a $400 per week benefit, with $300 paid through FEMA's Disaster Relief Fund and $100 matched by the state (which can use unexpended coronavirus funds or its own funds). It is all voluntary, so it is not clear how long it will take to put in place or how many states will have the funds to participate. But by the White House signing this EO it has signaled willingness to continue expanded benefits of $400 per week for the rest of the year vs. the $200 in the Senate bill and the $600 in the House bill.
Memorandum on Deferring Payroll Tax Obligations in Light of the Ongoing COVID-19 Disaster: This order defers payment of employee payroll taxes for employees earning up to approximately $104,000 per year, beginning September 1. The deferral lasts through 12/31/2020 and appears to be discretionary, though the Treasury Secretary is directed to explore ways to make it permanent. It is unclear what is to happen to the deferred tax, though the intent was to add to the employees gross income. If the deferral is not permanent the employee would have to repay beginning in January. LeadingAge will keep you informed on this EO and any regulations, guidance, etc.
Executive Order on Fighting the Spread of COVID-19 by Providing Assistance to Renters and Homeowners: This order replaces the moratorium on evictions that expired with a directive to CDC and the Secretary of HHS to "consider whether any measures temporarily halting evictions of tenants for failure to pay rent are reasonably necessary to prevent the spread of COVID-19 from one State to another." The Secs. of Treasury and HUD are directed to identify federal funds to provide temporary assistance to renters and may include providing assistance to landlords including affordable housing owners and public housing authorities. There is no timeline on implementing the order.

It is likely that these orders will bring continued discussion and will be superseded by legislation, which would be good since there is a question as to whether the President has the authority to issue these orders.

8/10/20: More on Testing: HHS Assistant Secretary for Health and White House testing coordinator Admiral Brett Giroir provided an update to LeadingAge about antigen testing and the machines that will be sent to all nursing homes in the country. Admiral Giroir noted that the ideal would be to provide low cost, 100% accurate PCR tests for all residents and staff, however, recognizing that is not possible with current shortages and test delays the Quidel and BD machines are the plan. Here is some additional information:

Concierge testing. Nursing homes are prioritized for antigen test kits.
State antigen testing policy. HHS is talking to health directors in several states with the hope that they will be open to changing their policies concerning not accepting antigen test results from nursing homes.
False negatives and double testing. Some research has shown that the tests are more accurate than originally thought (higher than the 85%) and FDA will change their labeling consistent with this research. Negative test results do not need to be repeated with a PCR test unless the person is highly symptomatic.

As always, more information will be shared as it becomes available.

8/10/20: Nursing Home Weekly Recap: Here is your recap of LeadingAge nursing home updates.

8/10/20: Housing Weekly Recap: Here is your recap LeadingAge housing updates.

8/5/20: Survey Stories? Recent survey? Confused by any of the outcome? We are trying to help. If you have a survey story, whether your story is one where ICAP instruction and your citations were conflicting, one where the findings just did not seem to include common sense, or one where you had a great result, please reach out and let us know. We are working to try to help provide examples to educate DHHS on the challenges. Email jenifer.acierno@leadingagene.org or call me at (402) 440-3327.

8/5/20: CDC Guidance on Reporting Lab Data: Yesterday, CDC updated guidance on reporting COVID-19 lab data. The guidance may serve as another resource to help make sense of it all. Remember: all nursing homes that use a point-of-care testing device must have a CLIA certificate of waiver, must use the device in the location for which the waiver is issued, and must report testing data to the state/local health department according to the process outlined by the state.

The Department of Health and Human Services has published a list that now includes 2,400 nursing homes - an additional approximately 1,800 more than the 636 that have already received antigen testing machines. The aim is to distribute the second tranche by mid-August. If you would like to see the list, click HERE. About ¼ of the way down the page, under "Supporting COVID-19 Testing", a link is embedded to access the list of facilities. When you click on this link, it opens a zip file containing the excel spreadsheet that lists the facilities. Separate tabs within the same excel file list the hot spot counties and the methodology for prioritizing facilities.

8/5/20: COVID-19 Supplemental Payment Requests due to HUD TODAY: Housing providers requesting reimbursement for COVID-19 expenses under the CARES Act have until midnight tonight, August 5th, to submit their request forms. More information from LeadingAge available HERE.

8/5/20: Action Alert: Join LeadingAge as we urge Congress to provide critical support to home and community-based services providers.

Leaders in Congress are negotiating the next major COVID-19 relief package. NOW is the time to make your voice heard to ensure that the critical needs home and community-based services providers are included in the final package. This includes support for adult day services providers, PACE organizations, and providers of in-home services (personal/home care, private duty nursing, and more). Send your message here: https://p2a.co/5DPDcKn

The House-passed Heroes Act recognizes the importance of home and community-based services in the continuum of care for older people. But the Senate package makes no mention of these important services.

Tell Congress that the next COVID-19 relief package must include home and community-based services provisions. Act now by emailing your members of Congress. Contact Congress here: https://p2a.co/5DPDcKn

8/3/20: CMS Releases SNF PPS FY 2021 Final Rule: On the afternoon of July 31, CMS released the FY 2021 skilled nursing facilities (SNF) prospective payment system (PPS) final rule. CMS largely limited the rule to required updates, which include a 2.2% market basket update, adoption of revised geographic delineations provided by OMB of urban/rural categories to calculate the wage index, and application of a 5 percent cap on any decreases in a provider's wage index from FY 2020 to FY 2021. CMS will not limit future decreases for FY 2022 which will lead to larger decreases in some geographic areas in the next rule making cycle. The rule finalizes some technical changes to ICD-10 mapping to selected PDPM categories as well as updates to the SNF VBP Program regulation text to reflect previously finalized policies.

8/3/20: FEMA PPE Update: LeadingAge has heard from some providers that they have still not received the second FEMA PPE shipment. FEMA official, Dave Sanford will join the LeadingAge national call on August 5 to discuss PPE. Those who have not previously signed up for calls can sign up here.

In the mean time, he indicated that if nursing homes have not received their packages from FEMA, they are invited to contact Dave at David.Sanford@dla.mil for assistance. Packages should include gloves, surgical masks, and gowns. If any items are not functional or usable Dave says first call the 1-800 number included in the package and then if you cannot resolve the issue, email Dave.

8/3/20: Changes to Provider Relief Funding Deadlines: On Friday night CMS/HHS released several changes to Provider Relief Fund dates.

Medicaid providers now have until August 28 to apply for funds. (The date was originally July 20, then it was extended to August 3; now it has been extended again.)
Medicare providers who missed the opportunity to apply for additional funding from the Phase 1 Medicare General Distribution now have a second chance, starting August 10 and going until August 28. These funds aim to offer providers financial relief up to 2 percent of their annual revenues. Some providers with low Medicare revenues did not complete this application.
Payments for providers who had a change of ownership. There is a window for them to apply from August 10 to August 28.

8/3/20: New Q & A Resource on Point of Care Testing: There have been, and likely will continue to be, many questions regarding point of care testing, antigen testing, and whether CMS will require staff testing related to the testing instruments that CMS is distributing to nursing homes. This LeadingAge Q&A includes a great deal of information, including answers to many of these questions.

For more information related to testing, see this MLN Matters article, specifically the section on Counseling and COVID-19 Testing that was updated on July 30.

8/3/20: HUD Updates Multifamily Q&A: On July 31, HUD issued its first update since May 21 of its Q&A for Multifamily Housing programs. HUD's July 31 Q&A document relays HUD's guidance on operational and procedural questions related to the safe administration of HUD-assisted programs during COVID-19. In the Q&A, HUD provides clarity on mask requirements for residents, testing requirements for residents, and Management and Occupancy Reviews.

8/3/20: HUD Tip Sheet for CSP Requests: Today HUD provided LeadingAge with a document titled "Tips for Completing HUD Form 52670-E." The document follows HUD's July 23rd announcement of COVID-19 Supplemental Payments (CSPs) for multifamily housing providers to request reimbursement for pandemic-related expenses. HUD staff answered additional questions related to reimbursement of COVID-19 related costs that are available here.

8/3/20: COVID-19 and Your Workforce: Legal Updates Webinar: Interested in legal updates related to COVID-19 and your workforce and need an opportunity to get up to speed? Check out this employment law webinar on the LeadingAge Learning Hub.

8/3/20: Nursing Home Weekly Policy Recap: For the week ending July 31, 2020

8/3/20: Senior Housing Weekly Policy Recap: For the week ending July 31, 2020

7/31/20: Announcement from LeadingAge National: Background: As we shared earlier this week, the U.S. Department of Health and Human Services (HHS) is considering a possible distribution of CARES Act Provider Relief Funds to private-pay assisted living/memory care providers that are stand-alone or part of a CCRC, located in the U.S states and territories. Argentum, ASHA, NCAL, and LeadingAge are assisting HHS in an effort to collect the necessary information from these providers through a private, secure data collection portal to help ease a potential future distribution of application funds. At this time, we have no guarantee such a distribution will happen, nor are we aware of an allocation methodology, if such a distribution were to occur. However, providing HHS with this data is an important step forward, and we appreciate your help in being responsive to their request. Providers should submit the relevant data into this portal by Monday, August 3 at 5 pm ET.

Data Submission Portal Information: Who is eligible to submit information?

We encourage private-pay assisted living and memory care providers that are stand-alone or those part of a CCRCs in the U.S. states and territories to submit their data. Please note that some states may use different terminology (e.g. personal care homes, supportive living facilities, etc.) to describe their licensed assisted living-type providers. All of these providers are encouraged to submit their information. For purposes of this portal, the term licensure also includes assisted living and memory care communities registered or certified by the state. Submitting your data does not guarantee you will receive or be eligible to receive a payment. You do not need to be a member of one of our senior living trade associations to participate in this secure and confidential data-collection effort.

What data must be submitted?

Name of licensed/registered/certified assisted living and/or memory care community
Name of entity that holds the license/registration/certification
Address
Community license/registration/certification number (some states may not provide a number)
Corresponding Tax Identification Number (TIN)
Taxpayer ID Number for the filing company
Contact information for the person submitting data
Include licensed assisted living that is part of a CCRC or a skilled nursing facility (SNF),even if the SNF has already received funding from the Provider Relief Fund.

Where do I submit the data? All of the above information should be submitted either manually or by uploading a specific file (see instructions for details) in the secure data collection portal. You will need to create an account. Please complete all the fields to ensure your submission will be accepted. Incomplete submissions will likely result in a delay in their inclusion.

What is the deadline to submit data? Please submit the requested data into the secure data collection portal by Monday, August 3 at 5pm ET.

Thank you for your quick action in support of this vital aid to our industry. If you have any questions, please contact us at: leadingage@leadingage.org

7/27/20: Testing in Nursing Homes: There is a CDC Clinical Questions about COVID-19 Q&A that addresses many of the questions that folks have been asking about what to do if a resident or healthcare provider declines a test or how to handle healthcare providers as they await their results. This Nursing Facility Testing Q&A may be helpful in answering those questions. For example:

Q: How should handle residents who decline testing?
- A: Residents, or their medical powers of attorney, have the right to decline testing. Clinical discussions about testing may include alternative specimen collection sources that may be more acceptable to residents than nasopharyngeal swabs (e.g., anterior nares). Providing information about the method of testing and reason for pursuing testing may facilitate discussions with residents and their medical powers of attorney.

If a resident has symptoms consistent with COVID-19, but declines testing, they should remain on Transmission-Based Precautions until they meet the symptom-based criteria for discontinuation.

If a resident is asymptomatic and declines testing at the time of facility-wide testing, decisions on placing the resident on Transmission-Based Precautions for COVID-19 or providing usual care should be based on whether the facility has evidence suggesting SARS-CoV-2 transmission (i.e., confirmed infection in HCP or nursing-home onset infection in a resident).

Only residents who have a confirmed positive viral test should be moved to COVID-19-designated units or facilities.

The Q&A link includes similar information related to healthcare providers declining testing....

7/27/20: COVID-19 Testing Equipment: LeadingAge members in other states have shared that some have received testing equipment. Those who received equipment also received notification via email that included a letter from CMS. The data collected through the NHSN system directly supports this initiative by helping to prioritize the nursing homes with testing needs and an increasing number of cases. This FAQ is helpful and provides some level of detail on the plans to roll out this testing equipment.

7/27/20: HUD / HHS Will Host July 29 Telehealth Webinar: HUD, along with the HHS office of the Assistant Secretary for Preparedness and Response, the HHS Administration for Community Living, is hosting a July 29, 2- 3pm ET, webinar, "Telehealth for Community-Based Organizations: Services, Payment, and Partners." To register for the July 29 webinar, visit this page.

7/24/20: Public Health Emergency Extended: Secretary Alex Azar renewed the Public Health Emergency, effective Saturday, July 25. The extension will continue for 90 days or may terminate earlier if the Secretary determines the emergency has ceased to exist. The renewal of the Public Health Emergency will result in the Section 1135 waivers continuing, unless they are individually terminated by the department. The LeadingAge waiver document has been updated.

7/24/20: Deadline Extended Medicaid And CHIP Provider Relief Fund: The deadline for qualified Medicaid and CHIP providers to apply for the Medicaid & CHIP Provider Relief Fund distribution has been extended. The Centers for Medicare/Medicaid Services (CMS) set a new deadline of August 3, 2020. The Nebraska Medicaid program encourages providers to apply. Nebraska Medicaid has issued the following Provider Bulletin 20-26 with more information.

7/24/20: COVID-19 Testing Equipment: Health and Human Services (federal) recently announced that they will begin providing nursing homes with a Point of Care (POC) rapid response testing instrument. The data collected through the NHSN system directly supports this initiative by helping to prioritize the nursing homes with testing needs and an increasing number of cases. For the methodology describing how facilities are prioritized, and a listing of the facilities, please click here. This FAQ is helpful and provides some level of detail on the plans to roll out this testing equipment.

7/24/20: Care and Coping with Dementia and COVID-19: We have talked a lot about the impact of isolation on people with dementia during this time. In this 18-minute QuickCast, Teepa Snow discusses Positive Approach to Care (PAC) strategies to support people living with dementia when sheltering in place. Available free of cost to LeadingAge members and non-members.

7/24/20: Senior Housing and Nursing Facility Weekly Recaps from LeadingAge: LeadingAge recently started providing these very helpful Weekly Recaps for both Senior Housing and Nursing Facility providers.

7/22/20: CDC: Updated Guidance on Isolation and Precautions for Adults with COVID-19 and Return to Work for Healthcare Workers and Test Based Strategies: Monday's update included a fair amount of information related to CDC guidance showing a move away from test based strategies. LeadingAge developed this quick reference document . Dr. Ashraf has indicated that he will discuss the changes as a part of tomorrow's LTC call with ICAP. Tune in tomorrow for more specifics related to the Nebraska approach.

7/22/20: *PPE AVAILABLE* We still have a limited amount of PPE available. If you need face shields, surgical masks, or cloth masks, please email me at jenifer.acierno@leadingagene.org and include the following information: Name and number of contact person, name and address of facility, what PPE you would like. PPE will be delivered or mailed depending on location.

We have a new opportunity for members who are interested in reusable gowns. Cornhusker State Industries (CSI) is a business affiliated with Nebraska Corrections. They have folks sewing gowns and masks. Please see examples below. They can only work with not-for-profits and have produced over 60,000 gowns so far. Gowns are made of orange twill material. Prices are listed below. The window mask does fog, so has to be treated with anti-fog spray or something similar.

Reuseable gown, sizes L ($9.85) and XL ($11.10) | Window masks-gray w/ tie string ($2.75), orange mask w/ tie string ($1.60)

IF you are interested in obtaining any of the items listed, please email me at jenifer.acierno@leadingagene.org and provide a contact person name and number, items you would like and quantity and we will determine whether to submit an order.

7/22/20: Join LeadingAge to Urge Congress for Relief to Aging Services Providers: The House and Senate are back at work negotiating the next big relief package. We have been advocating this summer for our 5 essential actions and it's time to get it over the finish line.

Congress needs to hear how many LeadingAge provider communities are struggling to obtain enough personal protective equipment, sufficient testing, and resources to keep the older adults they serve safe and healthy.

The negotiations are happening now and decisions will be made fast. Send a personal message to your U.S. Representative and U.S. Senators asking for crucial resources and immediate relief today.

Send a message to Congress here: https://mobilize4change.org/ZCwNBav

7/22/20: Administration Announces New Resources to Protect Nursing Home Residents Against COVID-19: The President mentioned Nursing Homes in his press conference today. Here is the CMS press release.

7/22/20: Provider Relief Funds Reporting Timelines Announced: The U.S. Department of Health and Human Services (HHS) outlined the timeline for providers to report on their use of Provider Relief Funds(PRF), for those who received $10,000 or more across all PRF payments, in a new PDF document on its website. The first report will be due no later than February 15, 2021. See more in this article from LeadingAge.

7/20/20: CDC: Updated Guidance on Isolation and Precautions for Adults with COVID-19 and Return to Work for Healthcare Workers and Test Based Strategies: Information from CDC indicates that they may be moving away from test based strategies due the fact that some people have prolonged viral shedding and will continue to test positive after they are no longer contagious. In these cases the test based strategy is of limited use in deciding when people can return to work and for deciding when to discontinue transmission based precautions for new and existing residents.

CDC, in a memo entitled Duration of Isolation and Precautions for Adults with COVID-19, indicates:

For most people with COVID, isolation precautions can be discontinued 10 days after symptom onset with symptom improvement and resolution of fever.
For most people a test based strategy to determine when to stop using isolation and precautions is no longer recommended; for those who are immunocompromised, a test based strategy could be considered in consultation with infectious disease experts.
For people who had symptomatic COVID and remain asymptomatic, retesting is NOT recommended within 3 months. Quarantine for these people is not recommended if they come in contact with someone who has COVID. However, these individuals MAY require retesting if they develop new symptoms.

In the memo entitled Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance), indicates:

Except for rare situations, a test based strategy is no longer recommended to determine when to continue transmission based precautions.
Transmission based precautions can be discontinued if the person has no fever for 24 hours and an improvement in symptoms after:
- 10 days after symptoms first appeared for those with mild to moderate illness who are not immunocompromised;
- 20 days since symptoms first appeared for those with severe to critical illness; and
- 20 days after the first positive viral test for severely immunocompromised patients who were asymptomatic
Specifically related to discharge of patients to a nursing home or other LTC facility (e.g., assisted living), patients can be discharged:
- If transmission based precautions are still required, the patient should go to a facility that can care for COVID patients;
- If transmission based precautions are not required, the patient does not require further restrictions.

Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance) indicates:

A test based strategy is no longer recommended to determine when to allow health care personnel with COVID to return to work.
Health care personnel with severe to critical illness or who are severely immunocompromised can return to work 20 days after their positive test.
Health care personnel with mild to moderate illness can return to work 10 days after symptoms first appeared and at least 24 hours since their last fever.

These are CDC guidance/recommendations. State and local health departments may adapt these to local circumstances. This potentially allows staff to return to work if they are no longer symptomatic, without testing required. CDC recommends that nursing homes no longer need a test based strategy to determine whether to admit individuals from the hospital.

See this article by LeadingAge for more information.

7/17/20: A note from Jenifer: Nursing Facility providers- ICAP is providing sound and reasonable assistance to many of you in relation to infection control challenges. Have you received a citation from DHHS surveyors when they do their infection control surveys when you are following ICAP guidance? I have heard from a number of you with these concerns and am collecting and sharing these examples with DHHS so they can evaluate these situations.

ALSO- if you have an example of being cited based on a QSO memo within the first few weeks that the QSO was issued and are willing to share, that would be great. It took a few weeks for the interpretation of the content of these memos to be made available. We have heard from the DHHS survey Interim Director that they have been providing an informal "grace period" during those time periods. Email me if you have examples that you would like to share. -Jenifer

7/17/20: HHS Announcement on Nursing Home Testing: As was included in Wednesday's update, HHS issued a press release that they plan to supply new, rapid point-of-care testing system to nursing homes. Instruments will roll out to hotspots first and it may take some months for the items to be available to nursing facilities. To be eligible to receive the antigen test machine a facility must have a CLIA certificate or a CLIA waiver. Nursing homes should begin the application process immediately to avoid any delays. CMS says that at this time, applications are processed within a few days. Here's the link CMS provided for how to apply: https://www.cms.gov/regulations-and-guidance/legislation/clia/downloads/howobtaincertificateofwaiver.pdf

7/17/20: Updated Provider Relief Document: I have been sharing the Provider Relief Document put together by LeadingAge over the past many weeks. This document was updated on Monday, so I am including it again for your review. Also, in conversation with Senator Fischer's staff a few weeks ago we were informed that the intent of the PPP SBA loans was to include both government owned hospitals AND nursing facilities. Originally, it was indicated that nursing facilities were not included in that option. *REVISION* If you are one of those facilities and you have not applied for those funds, you may want to reach out to your bank to discuss doing so. We are seeking additional clarification from Senator Fischer's office regarding eligibility of nursing facility providers.

7/17/20: SNF Quality Reporting Program Non-compliance Notices Issue-Reconsiderations Due Aug 18 *repeat: CMS has sent notices to SNFs if they are considered non-compliant with the SNF Quality Reporting program. If providers receiving this notice take no action, they will have their Medicare FFS rates reduced 2% beginning October 1. If providers wish to seek reconsideration of this status they must submit this information via email to CMS by August 18. Here is a link to the LeadingAge article that provides the details of this process and information on the restart of QRP data reporting.

7/15/20: HHS Announcement on Nursing Home Testing: As you may have heard over the past few days, HHS issued a press release and mentioned in a press conference on Tuesday plans to supply a new, rapid point-of-care testing system to nursing homes. The instrument can also be used for flu diagnostics. HHS plans to supply testing instruments and tests to all nursing homes in the country, beginning with 2,000 going out as early as next week to nursing homes prioritized by CMS. These prioritized nursing homes will be in current "hot spots". The rest of these allocations will be received in the following weeks. HHS states that this is a one-time procurement meant to augment current testing capacity. Once a provider runs out of the government-provided supplies, they can purchase additional supplies directly from the manufacturer. CMS held an open call this evening to further discuss this initiative with nursing home providers and here are some of the questions and answers from that call as provided by LeadingAge national:

How will nursing homes be prioritized to receive the instruments and tests, both in the first hot-spot allocation and in subsequent allocations? CMS is looking at CDC epidemiology data, NHSN reporting data, and other information to determine how nursing homes should be prioritized. They intend to make their selection methodology public in the coming days.
How long will the total distribution process take? This will be a "slow roll-out" taking place over weeks/months. A more precise timeline has not been finalized.
Will these instruments and tests go to all nursing homes, or only CMS-certified nursing homes? Nursing homes must have the CLIA certificate of waiver to receive the instrument and tests. Nursing homes should begin the application process immediately to avoid any delays. CMS says that at this time, applications are processed within a few days. Here's the link CMS provided for how to apply: https://www.cms.gov/regulations-and-guidance/legislation/clia/downloads/howobtaincertificateofwaiver.pdf.
When a nursing home runs out of tests, what will prices be like to secure more tests? How will we pay for tests? What steps will the government take to keep costs reasonable and to prevent scams and "counterfeit tests"? CMS will share information about how to pay for tests in the future, and will have CMS payment team available on future calls to answer provider questions. HHS is asking the manufacturers to communicate with nursing home providers to make purchasing additional tests an easy process.
What kind of training on the use of this testing instrument will be available? What kind of technical support will be available? HHS will be working with the manufacturer to be sure that training and technical support is available and is being widely used.
Understanding that this testing method will not replace other testing methods and strategies, will there be any guidance from CMS or CDC on how to prioritize the use of these tests? CMS will not direct providers on who to test or how to prioritize, other than to say that providers should use this allocation to meet CMS recommendations and state mandates for testing.
We have heard concerns about false negatives associated with this test method. Will CMS or CDC issue guidance on steps to take to minimize false negatives or mitigate the implications of a false negative? HHS says the tests are "somewhere in the neighborhood of 85%-90%" accurate and this accuracy beats having to wait days for a result. Positives are about 99% accurate.

7/15/20: Member Call Today with Connie Vogt, DHHS: Thanks to those of you who were able to join us for the call this morning with Connie Vogt, DHHS Program Manager for LTC Facilities. Today Connie presented on the array of Infection Control surveys that are currently underway including the COVID-19 Focused Infection Control (FIC) surveys. Just when we thought that the Focused Infection Control surveys were going to be done by the end of July, now there is another level of survey being put in place. The COVID-19 FIC requires the survey team to perform on-site surveys (within three to five days of identification) of any nursing home with: 3 or more new COVID-19 suspected and confirmed cases in the since the last National Healthcare Safety Network (NHSN) COVID-19 report or 1 confirmed resident case in a facility that was previously COVID-free. State Survey Agencies are encouraged to communicate with their State Healthcare Associated Infection coordinators prior to initiating these surveys. Connie indicated that Dr. Tom Safranek is currently serving in this role. Here is the PowerPoint from today's call. It is clear that there will be more to follow. The PowerPoint also includes information related to POC, EPOC and DPOC.

7/15/20: POC Help Sheet: Understanding CMS-2567

7/15/20: POC/EPOC and DPOC PowerPoint Presentation for LeadingAge NE and NHCA - Connie Vogt

7/15/20: Visitor Prep Sheet: LeadingAge has pulled together this Visitor Prep Sheet by reviewing the practices proposed in other states. It may be helpful to review as you consider your processes for visitors.

7/15/20: Updated Provider Relief Document: I have been sharing the Provider Relief Document put together by LeadingAge over the past many weeks. This document was updated on Monday, so I am including it again for your review. Also, in conversation with Senator Fischer's staff a few weeks ago we were informed that the intent of the PPP SBA loans was to include both government owned hospitals AND nursing facilities. Originally, it was indicated that nursing facilities were not included in that option. If you are one of those facilities and you have not applied for those funds, you may want to reach out to your bank to do so as the fund was reopened. ~Jenifer

7/15/20: Update on Rates from Jeremy Brunssen, MLTC Interim Director: During a standing call that we had earlier in the month with Jeremy Brunssen, Jeremy shared that the Medicaid team would be sending an email with NF providers (you may have received the note last week) that would provide additional specific direction on completing the Medicaid cost report in light of the current pandemic costs and funding streams. He indicated that the goal would be to help give directions for consistency for providers.

If you are an NF provider, you are aware that the nursing facility rate methodology went into effect for Nebraska on July 1, 2020. As a part of implementing changes to the methodology, going forward bed hold rates will now be paid at the resident's casemix rate, rather than the lower default rate. MLTC was unable to implement the necessary coding changes in time to implement that change by July 1, 2020 but anticipates that the change will occur in August and will be retroactive to the July 1, 2020 date.

7/15/20: CMS Extends Deadlines for HCBS Settings Rule: CMS extended many of the deadlines for the HCBS Settings Rule today. The final compliance deadline is now March 2023, and the heightened scrutiny deadlines are now July 2021. See the LeadingAge article HERE.

7/15/20: SNF Quality Reporting Program Non-compliance Notices Issue-Reconsiderations Due Aug 18: CMS has sent notices to SNFs if they are considered non-compliant with the SNF Quality Reporting program. If providers receiving this notice take no action, they will have their Medicare FFS rates reduced 2% beginning October 1. If providers wish to seek reconsideration of this status they must submit this information via email to CMS by August 18. Here is a link to the LeadingAge article that provides the details of this process and information on the restart of QRP data reporting.

7/15/20: *PPE AVAILABLE*: We still have a limited amount of PPE available. If you need face shields, mini hand sanitizers, surgical masks, or cloth masks, please email me at jenifer.acierno@leadingagene.org and include the following information: Name and number of contact person, name and address of facility, what PPE you would like, your daily gown burn rate, and whether you have COVID + in your facility. PPE will be delivered or mailed depending on location.

7/9/20: LTC Testing Update and Resources (shared by DHHS 7/2/20): The LTC Testing Process continues to evolve, so we are providing you with updated information to help the testing process flow more smoothly for you. Copies of the following guidance documents can be found on the Testing website at the link below.

Testing Instructions for LTC, Abbreviated Registration - these are the step-by-step instructions for completing the registration process which must take place at the time of specimen collection.
Long-Term Care Baseline COVID-19 Specimen Packaging and Shipping - these instructions provide information on packaging the specimens for shipment to the CHI St. Elizabeth Lab.

Training resources, including a video demonstration of the nasopharyngeal swab procedure, are included on the Testing website as well. We suggest that you contact resources in your community such as hospitals, physician offices, pharmacists, or nurse staffing agencies if you need health care providers to assist with performance of specimen collection. http://dhhs.ne.gov/Pages/Post-acute-and-Other-Facilities.aspx

We recently learned that the browser being used for registering persons for testing must be Google Chrome. Many facilities were having issues with the registration process when using Internet Explorer or other browsers. Below is a link to the LTC Testing Registration Process. https://covid19testingne.co1.qualtrics.com/jfe/form/SV_cJa8ezYYRQfZRCl?short_assessment=true

CHI St. Elizabeth Lab in Lincoln, NE, is the only approved laboratory for the LTC Testing Project. Specimens should not be sent to other laboratories if using the LTC Testing process. Please ensure the courier being used is taking the specimens to the CHI St. Elizabeth Lab. A facility may transport the specimens to the CHI St. Elizabeth Lab instead of using a courier. The Specimen Packaging and Shipping Instructions outline the process that must be followed.

If your facility is in need of additional test kits beyond what was initially requested, please contact your Local Health Department to request additional test kits for urgent needs. We are working to provide an additional supply of test kits to the Local Health Departments to have on hand for these urgent requests.

From the desk of: Becky Wisell |DHHS Administrator II, DIVISION OF PUBLIC HEALTH, LICENSURE UNIT, Nebraska Department of Health and Human Services, OFFICE:402-471-0179 | CELL:402-610-5122 | FAX:402-471-3577

7/9/20: SNF EPOC's for COVID 19 Focused Infection Control Surveys and F884 (shared by Connie Vogt 7/9/20): We are starting to receive the EPOC (Electronic Plan of Care) for the COVID 19 Focused Infection Control Surveys and many of them are not meeting the CMS criteria specific to these COVID 19 Focused Infection Control Surveys. Please share this information with your SNF/NF facilities to develop acceptable EPOC's for both the Licensure unit and the CMS surveys that were conducted. Again we strongly encourage all of the SNF/NF facilities to be enrolled in EPOC.

The facilities need to:
A) Ensure the EPOC contains all of the elements outlined in the POC are documented in the EPOC
B) Ensure the EPOC contains the required information under Enforcement Remedies.
a. New in this process is the DPOC Directed Plan of Correction
i. The facility MUST complete the appropriate videos and submit documentation with the EPOC

For F884 Failure to report to the National Health Safety Network
A) These are posted in EPOC
B) These are generated offsite by CMS

From the desk of: Connie Vogt, RN, BSN, Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS, PO Box 94986, 301 Centennial Mall South, Lincoln, Nebraska 68509-4986, (402) 471-3324, FAX: (402) 471-0555

7/3/20: The member call on Wednesday, July 8, with Connie Vogt and other representatives from DHHS is CANCELLED and will resume on July 15.

7/1/20: *PPE AVAILABLE*: As was shared yesterday, we were very lucky to get a large supply of gowns in for our members. We have enough to fill all requests that have come in so far and more. If you need gowns, surgical masks, or cloth masks, please email me at jenifer.acierno@leadingagene.org and include the following information. Name and number of contact person, name and address of facility, what PPE you would like, your daily gown burn rate, and whether you have COVID + in your facility. PPE will be delivered or mailed depending on location.

7/1/20: HHS Announces Extension of Public Health Emergency by Tweet: The Public Health Emergency is set to end on July 25th. On that basis, LeadingAge sent a request to HHS Secretary, Alex Azar, requesting an extension. The HHS Assistance Secretary for Public Affairs tweeted that the PHE would be extended. We are currently unsure how that will impact the various 1135 waivers. When there is more formal/specific information on the potential extension, we will provide an update.

7/1/20: Testing Update for Today: If you were able to join us on today's member call, you probably heard that the testing roll-out has been a very bumpy process. I don't have much of an update to provide, other than both staff and residents register at the time of the testing. They cannot be pre-registered. It sounds like additional direction will be coming from Becky and Dan and will be posted on the DHHS website. I will let you know when we get additional information on that.

If you have questions related to testing you can send an email to: dhhs.ltctesting@nebraska.gov, becky.wisell@nebraska.gov, or daniel.taylor@nebraska.gov.

7/1/20: HUD CFO Issues CARES Act Plan: This week, HUD published a plan for the $12.4 billion in CARES Act relief funding appropriated for the agency in late March. The comprehensive plan discusses a response team assembled by HUD for CARES Act disbursement, communication efforts with stakeholders, and funds allotment for various programs. For senior housing, the plan says that the agency will make some of the $40 million in funds available to help owners experiencing significant operating cost increases and financial hardships as a direct result of COVID-19; for service coordinators, the plan states that HUD will focus the $10 million in CARES Act funds on grant-funded service coordinators, as opposed to both budget-based and grant-based personnel. More details for senior housing CARES Act funds are expected from the agency within 30 days.

6/26/20: DHHS Announces Community CARES- Coronavirus Relief Fund: Yesterday during his Press Conference, Governor Ricketts announced the CARES Coronavirus Relief Fund. This fund provides options for three different ypes of grant funding available to specific 501(c)(3) organizations in Nebraska. These funds are being made available to help offset lost revenues and increased expenses related to COVID-19. Funding is open to 501(c)(3) Nursing Facilities, Adult Day Services, Assisted Living, Hospice and others. Some providers types are specifically excluded, such as hospitals and units of local and tribal government. Providers can apply for more than one grant type. You can view the details for each grant type HERE. Application and instructions will be made available on the DHHS website.

6/26/20: CMS FAQ on Visitation: In Wednesday's update you saw that CMS released an FAQ document on nursing home visitation. The LeadingAge article regarding is availableHERE.

6/26/20: CMS Memo on 5 Star Quality Rating System: Yesterday, CMS released nursing home memo QSO-20-34-NH that announces changes to the 5 Star Quality Rating System on Nursing Home Compare and the end of an 1135 waiver. Changes to the Nursing Home Compare Website and Five Star Quality Rating System:

Staffing Measures and Ratings Domain: On July 29, 2020, Staffing measures and star ratings will be held constant, and based on data submitted for Calendar Quarter 4 2019.
- Also, CMS is ending the waiver of the requirement for nursing homes to submit staffing data through the Payroll-Based Journal System. Nursing homes must submit data for Calendar Quarter 2 by August 14, 2020.
Quality Measures: On July 29, 2020, quality measures based on a data collection period ending December 31, 2019 will be held constant. While certain quality measures will be held constant the quality measure rating will NOT be held constant.

More to come on this.

6/26/20: Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19): Today, CMS revised the Medicare FFS Response to Public Health article and shared it on MLN to add the section, "Skilled Nursing Facility (SNF) Benefit Period Waiver - Provider Information" and related billing instructions. All other information remains the same. There have been a number of questions on how to handle and bill with the benefit period waiver.

6/26/20: HHS Clarifies Provider Relief Medicaid Distribution Application Items: LeadingAge has provided this article related to the Medicaid Distribution Application. The Department of Health and Human Services, through a series of webinar this week, has updated the FAQ document related to the new Medicaid Distribution application process as well as how providers should report revenue information.

6/26/20: Home Health Proposed PPS Rule: The proposed home health prospective payment rule was released yesterday. The rule would update the home health prospective payment system (HH PPS) payment rates and wage index for calendar year (CY) 2021 with a market basket update of 2.6%. This proposed rule also would make permanent the changes to the home health regulations regarding the use of technology in providing services under the Medicare home health benefit as described in the Medicare and Medicaid Programs; Revisions in Response to the COVID-19 Public Health Emergency interim final rule with comment period.

6/26/20: Life Safety Compliance and 1135 Waivers: This article "Navigating 1135 Waivers Affecting Life Safety Compliance" is from LeadingAge's life safety consultants. It explains what is relaxed through 1135s and what providers must still comply with and how. It also has a section on fire drills, which can be waived. Providers must document that they have a staff training program, but there is no specific guidance from CMS about what the training must look like or how it is to be delivered.

6/26/20: DHHS Announces Community CARES- Coronavirus Relief Fund: Yesterday during his Press Conference, Governor Ricketts announced the CARES Coronavirus Relief Fund. This fund provides options for three different types of grant funding available to specific 501(c)(3) organizations in Nebraska. These funds are being made available to help offset lost revenues and increased expenses related to COVID-19. Funding is open to 501(c)(3) Nursing Facilities, Adult Day Services, Assisted Living, Hospice and others. Some providers types are specifically excluded, such as hospitals and units of local and tribal government. Providers can apply for more than one grant type. You can view the details for each grant type HERE. Application and instructions will be made available on the DHHS website.

Essentially, there are three types of funding available:

Community CARES Stabilization Grant-One-time payment of at least $12,000 for charitable organizations and eligible provider organizations. Applicants must have sustained increased costs and/or lower revenue/income due to COVID-19. Total allocation: $40 million. Applications open: June 29-July 6, 2020. To apply: dhhs.ne.gov/CommunityCares

Community CARES Response & Recovery Grants (traditional grant)- Competitive grant opportunity for non-profits and eligible provider organizations. Total allocation: $43 million. Applications open July 1-8, 2020. To apply: dhhs.ne.gov/CommunityCares

Community CARES Healthy Places Grant for Child Care Providers & Centers of Worship-One time payment of at least $250 for licensed child care providers, license-exempt subsidy child care provider, and centers of worship. Funds will be used for the purchase of PPE and cleaning supplies. These health and safety supplies will help mitigate the spread of COVID-19 across Nebraska. Total allocation: $2 million. Applications open July 6-12, 2020. To apply: dhhs.ne.gov/CommunityCares

6/25/20: Educational Videos, Procedures and Forms from DHHS Website

6/24/20: CMS Issues Nursing Home Visitation FAQ: Today, CMS issued a Nursing Home Visitation FAQ. A summary from LeadingAge will be available soon. Here are a few highlights: CMS reiterates that generally, visitation is restricted until a nursing home enters Phase 3 of reopening recommendations. Some visitation may take place prior to Phase 3, such as outdoor visitation done with appropriate precautions. CMS also clarified that visitation in "compassionate care situations" is broader than end-of-life situations. CMS says that if in-person visitation by the ombudsman is restricted that the ombudsman must still be guaranteed access to the resident and the nursing home must help facilitate this access for other access, such as virtually or by telephone.

6/24/20: Testing Update for Today: If you were able to join us for today's member call, you probably heard Dan Taylor answer a number of questions related to testing. We are very grateful that Dan was able to join us and hope that he will be able to join us again next week. Dan provided the following TESTING KIT DELIVERY document. Take a look to see what day of the week kits will be delivered to your Local Health Department.

In case you were unable to make one of the testing calls that DHHS held last week, or maybe you just want a review, here is the presentation: LTC Baseline COVID-19 Testing PowerPoint Presentation. One clarification, your baseline testing must occur within the 30 days prior to your entry to Phase III.

If you have questions related to testing you can send an email to: dhhs.ltctesting@nebraska.gov.

6/24/20: NHSN Reporting Enforcement: Some members are receiving citations and CMPs related to NHSN reporting and are not receiving a warning letter that was set out in the process outlined in QSO-20-29-NH. CMS has indicated that the warning letters were only provided in the early weeks of reporting and that they are no longer issuing warning letters for initial episodes of noncompliance. CMS recommends the IIDR process. CMS is unsure how long the IIDR process will take, but is open to reviewing and overturning fines when warranted and will reconcile CMPs that accrue for an overturned decision.

6/24/20: CMS Covid-19 Data and Highlights: With the first few weeks of reporting underway through NHSN, there has been a fair amount of data made available. LeadingAge has pulled together initial impressions of what this data demonstrates in THIS ARTICLE.

6/22/20: Medicare COVID-19 Testing Announcement: Medicare Coverage of COVID-19 Testing for Nursing Home Residents and Patients CMS instructed Medicare Administrative Contactors and notified Medicare Advantage plans to cover coronavirus disease 2019 (COVID-19) laboratory tests in nursing home residents and patients. This instruction follows the Centers for Disease Control and Prevention's (CDC) recent update of COVID-19 testing guidelines for nursing homes that provides recommendations for testing of nursing home residents and patients with symptoms consistent with COVID-19 as well as for asymptomatic residents and patients who have been exposed to COVID like in an outbreak. Starting on July 6, 2020, and for the duration of the public health emergency, consistent with sections listed below of CDC guidelines titled, "Interim SARS-CoV-2 Testing Guidelines for Nursing Home Residents and Healthcare Personnel," Original Medicare and Medicare Advantage plans will cover diagnostic COVID-19 lab tests and non-cover tests not considered diagnostic. * Viral Testing of Residents for SARS-CoV-2 * Initial Viral Testing in Response to an Outbreak * Recommended testing to determine resolution of infection with SARS-CoV-2 * Public health surveillance for SARS-CoV-2 Tests that are considered non-diagnostic are not covered.

6/22/20: Baseline Testing Timeframe *UPDATED FRIDAY*: Last week, we heard from DHHS that mandatory baseline testing of staff HAD to be accomplished within the 14 days preceding June 22nd to meet the requirements for staff testing for Phase III. On Friday afternoon we were informed by DHHS that as long as your baseline testing was conducted in the 30 days prior to June 22nd (May 24 or after) you CAN use those testing results as your mandatory baseline for Phase III. As a reminder, you must also meet the other requirements outlined in the Phasing Guidance to move to Phase III.

6/22/20: PPE Available: LeadingAge Nebraska has been fortunate to get generous donations of funding or supplies for PPE for our members. Donations continue to come in from local sewing groups, a sponsor through the University of Nebraska Omaha, Department of Gerontology, and others.

We have mailed and delivered a large quantity of PPE. We have a limited quantity of the following on-hand currently:

Surgical masks
Cloth masks
Face shields
Hand sanitizer

Please reach out to me directly (jenifer.acierno@leadingagene.org) if you are in need of any of these items and we can deliver or mail them to you.

6/22/20: Nebraska COVID-19 LTC Data

Facility Type	Resident	Death	Staff
Skilled Nursing/Nursing Facilities (SNF/NF)	454	84	375
Assisted Living (ALF)	144	20	145
Total	598	104	520

	This data is CUMULATIVE	Data from Jun 8 through Jun 21
Numbers of Residents with COVID-19 Positive Status	598	37
Number of COVID-19 Related Deaths (validated count only)	104	2
Numbers of Staff with COVID-19 Positive Status	520	31
Total Number of Facilities Affected by COVID-19	142	12 (new facilities)
Facilities Where only Resident(s) Tested Positive for COVID-19	7	0
Facilities Where only Staff Tested Positive for COVID-19	85	11
Facilities Where both Resident and Staff Tested Positive for COVID-19	50	12

6/19/20: Baseline Testing Timeframe *BREAKING NEWS*: In the past week, we heard from DHHS that mandatory baseline testing of staff HAD to be accomplished within the 14 days preceding June 22nd to meet the requirements for staff testing for Phase III. This afternoon we were informed by DHHS that as long as your baseline testing was conducted in the 30 days prior to June 22nd (May 24 or after) you CAN use those testing results as your mandatory baseline for Phase III. As a reminder, you must also meet the other requirements outlined in the Phasing Guidance to move to Phase III.

6/19/20: Administration for Community Living Webinar on Technology and Social Isolation: On June 26, the Administration for Community Living/US Department of Health and Human Services, will host a webinar "Addressing Social Isolation through Technology Solutions," from 1:00 - 2:00 Eastern. Majd Alwan and Scott Code of LeadingAge CAST will present.

6/19/20: Advocacy Campaign: Act for Older Adults: LeadingAge continues to advocate for our provider members across the full continuum of care. LeadingAge national is ramping up advocacy work during June and July to ensure that Congress's next relief package includes support that's aligned with our Five Essential Actions for Older Adults. Next Tuesday will provide opportunities to carry the message!

6/19/20: TODAY: Now we're asking every LeadingAge member organization to add its name to our COVID-19 legislative asks. Signing on takes just a few moments -- but will have incredible impact on Capitol Hill. Be sure YOUR organization is counted among supporters!

We hope that you will support these efforts. Together, we can influence this critical legislation and ensure that Congress delivers real relief for aging services providers and millions of older adults!

6/19/20: Reopening Resources Insights and Tools: When it comes to the full spectrum of aging services, there's no one way to approach reopening and recovery. We trust our providers to forge their own best path, and LeadingAge staff experts are developing articles and materials to help you make decisions.

6/19/20: COVID-19 Response Plan Confirmation Due Monday (6/22/20): As a reminder, if you are an NF or AL you need to complete your COVID-19 Response Plan by June 22nd (Monday). When you complete your planning, you should keep a copy of it with your Emergency Preparedness Plan. The plan should be made available at the request of your local health department or DHHS. You should also send an email notification to DHHS.HealthCareFacilities@nebraska.gov indicating that you have completed your plan. The email should include your facility name and license number. You DO NOT need to submit the actual plan.

6/19/20: Pandemic Disaster Preparedness: FEMA has published an exercise starter kit for providers to update emergency response plans during the health crisis. The kit includes samples slides and discussion questions for providers across the continuum to adapt current hurricane (or other) disaster response plans to the pandemic.

6/19/20: PPE Available: LeadingAge Nebraska has been fortunate to get generous donations of funding or supplies for PPE for our members. Donations continue to come in from local sewing groups, a sponsor through the University of Nebraska Omaha, Department of Gerontology, and others.

We have mailed and delivered a large quantity of PPE. We have a limited quantity of the following on-hand currently:

Surgical masks
Cloth masks
Face shields
Hand sanitizer

Please reach out to me directly (jenifer.acierno@leadingagene.org) if you are in need of any of these items and we can deliver or mail them to you.

6/17/20: Temporary Waiver of Prior Auth for Transfer: As a reminder to Nebraska Medicaid providers, the temporary waiver of prior authorization for the transfer of patients to certain facilities has expired effective May 31, 2020. The following transfers again require prior authorization:

Post-acute LTAC, acute inpatient rehabilitation, or skilled nursing facility;
Transfer to a new long-term care provider; and
Observation.

Additionally, prior authorizations for elective surgeries and therapies that expire June 1 and forward will no longer receive an automatic 90-day extension.

Please see Provider Bulletin 20-11 for more details.

6/17/20: Paycheck Protection Program Loan Forgiveness: LeadingAge has posted an overview of the Paycheck Protection Program's new EZ Application Form for forgiveness. On June 16, the Small Business Administration and the Department of Treasury announced a simplified loan forgiveness application for PPP borrowers. The article provides information on the simplified application form.

6/17/20: Provider Relief Fund: HHS has posted links for a webinar that it is hosting about the Medicaid Targeted Distribution application process. See below for the registration links for the two webinar dates. As part of the registration process.

Join our webcast to learn more about the application process. Please pre-register to reserve a spot on your preferred date:

6/17/20: Staff Vacations and Travel Considerations During COVID-19: As restrictions loosen and travel restrictions begin to lift around the country, members are tackling the question of what to do about managing the risk of staff (and resident) travel for vacation and other non-essential leave requests. LeadingAge provides a review CDC guidance, outlines a variety of member solutions, and discusses the legal and liability considerations as a part of these issues.

6/17/20: House Coronavirus Oversight Committee: The House committee overseeing the federal response to the coronavirus crisis is launching an investigation into the country's five largest for-profit nursing home companies, seeking details about their structure, executive compensation and preparedness for coronavirus. The Committee also sent a letter to CMS criticizing the agency's response to COVID.

6/17/20: Community Development Block Grant (CDBG) as Resource for Senior Housing COVID-19 Costs: Since March 27, state and local governments have received $3 billion of the CARES Act's $5 billion for COVID-19 relief from HUD's Community Development Block Grants program. Funds could be used for PPE, for meals and food, and for cleaning and disinfecting, among other uses. Here's a link to an article about CDBG as a resource for senior housing COVID-19 costs. Contact your local housing or community development offices for more information.

6/17/20: Advocacy Campaign: Act for Older Adults: LeadingAge continues to advocate for our provider members across the full continuum of care. LeadingAge national is ramping up advocacy work during June and July to ensure that Congress's next relief package includes support that's aligned with our Five Essential Actions for Older Adults.

Today, LeadingAge launched the new advocacy campaign "Act for Older Adults." Members, residents, families, and everyday Americans are being asked to fight for older adults during this pandemic. LeadingAge sent a letter to Congress filled with robust and detailed asks, and members like you have already joined over 25 meetings with congressional offices. Over the next weeks, you can expect action alerts, sign-on letters, social media posts and other materials to help extend the campaign. We'll soon launch a new web page to house messages and materials.

6/17/20: Hospice Article Update: The recent FAQs related to hospice have been updated. The update clarifies that hospices should only discharge patients if they have documented reasonable attempts and still have been unable to make a visit in person or using the telehealth waivers.

6/15/20: Governor Announces Phasing Plan for LTC: During today's press conference, Governor Ricketts announced a number of upcoming changes to DHMs across the state. He also announced the new Phasing Plan for Nursing Facilities and Assisted Living. Most counties (excluding Hall, Hamilton, Merrick and Dakota) are moving to Phase III on June 22nd. The four excluded counties will move to Phase II on June 22nd. There are certain requirements for NF and AL prior to being able to move between phases that must happen before a NF or AL makes the move. Review in the attached Phasing Plan that was sent out by DHHS today for more details.

6/15/20: CDC COVID-19 LTC Infection Prevention and Control Strategies Webinar: Tomorrow CMS will hold their Clinician Outreach and Communication Activity (COCA) call. Presenters will discuss how to apply infection prevention and control guidance for nursing homes and other long-term care facilities as they continue to prepare and respond to COVID-19.

Date: Tuesday, June 16
Time: 1:00-2:00 p.m. CST
Webinar Link: https://www.zoomgov.com/j/1615543668

6/15/20: NHSN LTC Data Quality Webinar: The CDC will host a LTC COVID-19 Data Quality Webinar tomorrow, Tuesday, June 16 from 12:00-1:00 p.m. CST. The CDC has been recording and posting all of their training videos on the COVID-19 LTC Module, so it is likely that the webinar will be posted to the site a few days following the webinar as well. If you would like to join the webinar, space is limited. Click here to register for the webinar.

6/12/20: Update on Phasing Roll-Out: If you were able to join us for today's member call, you heard Dr. Anthone share that the plan for phasing should be available toward the beginning of next week. That is good news. More to come next week.

6/12/20: Clarifications on the Medicaid Provider Relief Fund Distribution: During today's LeadingAge call, Senior Advisor to Alex Azar, Nick Uehlecke, indicated that the deadline for Medicaid providers to apply for Medicaid Provider Relief funds was extended to July 20 to be consistent with application time frames extended to other provider types. Mr. Uehlecke said that providers, like adult day centers, who had to close their physical site were still eligible to apply for funding. He noted that HHS is working to resolve issues related to Medicaid providers who are part of the same tax ID number as a Medicare provider that already received funds. Here is an article from LeadingAge with more information.

6/12/20: Paycheck Protection Program Guidance Implements Flexibility Act- Rules Updated: The SBA issued an updated rule for PPP borrowers and potential borrowers following the Flexibility Act's passage. The Flexibility Act's key provisions include extending the time to use loan funds from 8 weeks to 24 weeks, reducing the amount of loan dollars to be used for payroll costs from 75% to 60% and extending deferral periods for repayment and, for new loans, maturity. For more information see this article from LeadingAge.

6/12/20: CMS Issues Non-LTC FAQs: On June 10 CMS issued and answered some new FAQs on Non-Long-Term Care Facilities and ICFs/IIDs. Some hospice related issues are included. See this article describing the hospice related provisions. More to come related to the ICF/IID FAQs soon. The FAQs indicate that is hospice staff have appropriate PPE and do not meet the CDC criteria for restricted access they should be let into nursing facilities to visit patients.

6/12/20: NHSN Reporting Problems? If CMS is indicating that you still have not reported to NHSN and you think that you have, here is a tool that describes potential problems that may have occurred and how to solve them.

6/12/20: CMS Guidance on Resident Stimulus Checks: Yesterday, CMS put out a press release reminding providers that they can not seize residents' stimulus checks. CMS indicated that seizing of checks is considered a violation of the regulation governing Freedom from Abuse, Neglect and Exploitation and that nursing facilities who seize checks could be subject to federal enforcement actions, including potential termination from participation in the Medicare and Medicaid programs.

6/12/20: LeadingAge National 3-Minute Member Survey re: PPE LeadingAge is working very hard to address the issues of LTC and PPE on a national level. They are working urgently to get a snapshot of the current state of personal protective equipment and testing among our membership. Please answer these fast questions to help assure the reality on the ground is reflected clearly in the media.

6/10/20: HHS Announces new Targeted Medicaid/CHIP Distribution from Provider Relief Fund: Yesterday, HHS announced the next round of provider relief funding it intends to distribute. This round is focused on Medicaid and CHIP providers. The Application Portal opened today and will stay open until July 3rd.

Who is eligible? Providers who did NOT receive a General Distribution payment (these went to Medicare providers who may also provide Medicaid), provider who participate in Medicaid and/or CHIP programs AND who billed Medicaid FFS or Medicaid Managed care between 1/1/2018 and 5/31/2020.

How will providers get the payment? Under a new approach, providers must apply by submitting required information through a new "Enhanced Provider Relief Fund Payment Portal". HHS has said providers will need to submit annual patient revenue and # of Medicaid patients/beneficiaries served.

How much will a provider receive? HHS reports providers will be eligible to receive payments of at least 2% of reported gross revenue from patient care.

Here is an article covering from LeadingAge that covers this information. https://leadingage.org/regulation/hhs-announces-new-medicaidchip-distribution-provider-relief-fund-application-portal-opens

6/10/20: Long-Term Care Testing Plan- UPDATE: Testing plan OVERHAUL. If you were able to join our member call today with Z. Winfrey and Connie Vogt you heard that the DHHS approach to baseline testing has shifted quite a bit since last Friday. Last week, it was indicated that the testing process would start in Lancaster and Douglas counties. That of course was concerning for providers located outside of those counties that would like to start phasing steps. What we heard today is to expect an announcement by the end of the week regarding statewide testing that will be made available to NF and AL providers AND others who serve vulnerable populations. This testing can be used as baseline testing for your staff. If there has been a positive in your facility or staff come back positive this will result in resident testing as well.

IF you have completed your own baseline testing with staff since the week of May 25, 2020 you can use this testing information for your baseline. The information will need to be reported to DHHS. More information will be rolling out related to the testing guidelines and availability by the end of this week. If you have specific questions about testing at this point, you can contact Z Winfrey with DHHS. Her email is zidarta.winfrey@nebraska.gov and her number is (402) 471-2736.

Z indicated that there will be a daily presentation of the details for this new state wide Long Term Care Facility Baseline Testing Project starting on June 15 from 4:00-5:00 CT. To join the Webex calls click HERE.

Meeting access code: 145 603 4492 Meeting password: Qk5DvSdYM68

If you would like to schedule an individual call after attending one of the information sessions please Z at zidarta.winfrey@nebraska.gov to arrange that. As always, more information to follow.

Contact information for Zidarta Winfrey “Z”, Hospital Preparedness Program Coordinator Bioterrorism| Preparedness and Emergency Response| PUBLIC HEALTH
Nebraska Department of Health and Human Services
OFFICE: 402-471-1993 | CELL: 402-560-1679 | FAX: 402-471-2736 | HOTLINE: 402-471-1983

6/10/20: Notice Process and Fines for NHSN Reporting: CMS Region 7 indicated today that it would be using the CASPER system to communicate deficiency notices and corresponding enforcement actions. It was indicated that use of CASPER is necessary to automate the enforcement notice process due to the volume of cases and the given time frames.

CMS Region 7 indicates that they are aware of the systems issues that some providers have experienced and that they are in the process of reviewing these situations to ensure we have a process that is fair to providers. In the meantime, providers who have received a CMP related to CDC reporting for circumstances beyond their control should submit an IIDR request to challenge the findings.

Requiring providers to submit an IIDR when the process was rushed and the ability to register providers was clearly challenged seems onerous for providers, but it seems that this will be the approach used for now. The documents/emails that we discussed providers maintaining when encountering difficulty with registration or reporting should help with an IIDR. Hold on to all of your exchanges related to difficulty with registration or reporting.

6/10/20: Nebraska specific data related to COVID-19 positive staff, residents, and facilities as of 6/9/2020

Facility Type	Resident	Death	Staff
Skilled Nursing/Nursing Facilities (SNF/NF)	405	79	317
Assisted Living (ALF)	117	19	112
Total	522	98	429

Numbers of Residents with COVID-19 Positive Status	522
Number of COVID-19 Related Deaths (validated count only)	98
Numbers of Staff with COVID-19 Positive Status	429
Total Number of Facilities Affected by COVID-19	122
Facilities Where only Resident(s) Tested Positive for COVID-19	8
Facilities Where only Staff Tested Positive for COVID-19	75
Facilities Where both Resident and Staff Tested Positive for COVID-19	39

6/8/20: DHHS Issues Urgent Memo re: N95 Vented/Valved Masks: The Department of Health and Human Services (DHHS) issued a letter today indicating that it has been notified that many health care facilities and services have received and are having staff use N95 "vented" (with valve) masks. All health care facilities and services must immediately stop the use of N95 "vented" (with valve) masks by both staff and residents/patients/clients. Included are examples of the types of N95 "vented" (with valve) masks that all health care facilities and services MUST STOP using immediately.

6/8/20: Annual Physical Requirements for Medicaid-Eligible Residents of Long-Term Care: Today, the Division of Medicaid and Long-Term Care issued Provider Bulletin 20-19. This bulletin addresses the federal regulations that require that physician's visits occur every 30 days for the first 90 days from the date of admission, and then every 60 days thereafter. It provides that during the COVID-19 emergency, telehealth may be used for any of these physician visits. In addition, during the COVID-19 emergency, Nebraska Medicaid is waiving the annual physical exam requirement for Medicaid beneficiaries who are residents of long-term care nursing facilities. Providers must still use their medical judgment to meet the specific care needs of long-term care nursing facility residents, whose circumstances in some cases may still require face-to-face visits.

6/8/20: Long-Term Care Testing Plan- UPDATE: If you are a facility (NF or AL) in Douglas or Lancaster counties, you might have been contacted by DHHS to start COVID-19 baseline testing for your staff. Based on your feedback, not everyone in those counties has been contacted.

On last Friday's member call with Drs. Ashraf and Anthone you may have heard that if you are in a low-incident county, it could be a month or two before you are prioritized for testing under the DHHS plan. If you have the option to test your staff or Test Nebraska is going to be in your community, it may be best to get a baseline sooner than later. It was announced on the call that it could be over two weeks before a phasing plan is shared by Nebraska DHHS. Of course, we are sharing our thoughts about the need for this to happen as soon as possible and to be facility specific. In the meantime, you are working on developing your plan to loosen restrictions which is more challenging without the phasing document.

Again, participation in this testing is not mandatory, but the state has verbally indicated that a baseline is necessary to begin moving through the phases of reopening, in particular in relation to NF. We are still reviewing the requirements for AL, but at this point the state has asked AL to proceed under the same approach as NF even though there has not been any directive issued requiring this. More to come on this issue as research continues.

6/5/20: Long-Term Care Testing Plan- UPDATE: If you are a facility (NF or AL) in Douglas or Lancaster counties, you have likely been contacted by DHHS to start COVID-19 baseline testing for your staff. Some of you may have already completed some portion of your testing already. You may have also heard during today's member call with Drs. Ashraf and Anthone that if you are in a low-incident county that it could be a month or two before you are prioritized for testing under the DHHS plan. If you have the option to test your staff or Test Nebraska is going to be in your community, it may be best to get a baseline sooner than later. It was also announced on the call that it could be over two weeks before a phasing plan is put out by Nebraska DHHS. In the meantime you are working on developing your plan to loosen restrictions which is more challenging without the phasing document. That fact was shared again during today's call.

Again, participation in this testing is not mandatory, but a baseline is necessary to begin moving through the phases of reopening, in particular in relation to NF. The state is asking the same for AL as far as testing and phasing, but there has not been any directive issued requiring this. More to come on this issue as research continues.

6/5/20: NHSN Data and Infection Control Surveys: CMS released the full data from nursing homes' NHSN reporting yesterday. The data is available at data.cms.gov and there is a link to this data on the Nursing Home Compare site. Here is the CMS press release.

All data elements entered into NHSN are reflected for the reporting periods ending May 24 and May 31. You can also see if a nursing home did not submit data or if the data submitted did not meet validation criteria. The data file will be updated in 2 weeks and then on a weekly basis.

6/5/20: Frequently Asked Questions COVID-19 Data Published by the Centers for Medicare and Medicaid Services: The Centers for Medicare and Medicaid Services (CMS) COVID-19 NHSN reporting requirements for nursing homes became effective on May 8, 2020. Data submitted to NHSN are shared with CMS on a weekly basis, enabling the agency to evaluate requirement compliance and publicly publish facility-level information. CMS memo QSO-20-29-NH provides additional information for nursing homes to meet COVID-19 reporting requirements. See these updated FAQs.

6/5/20: New Provider Relief FAQs Discuss Expenses and Lost Revenues: On June 4, the Department of Health and Human Services (HHS), in its recently updated Provider Relief Fund FAQ document, begins to offer more clarity on some long-unanswered questions regarding what HHS considers eligible expenses and lost revenues, for which a provider can use Provider Relief Fund payments. See the LeadingAge analysis here.

6/5/20: CARES Fund Ask for HUD Providers: President and CEO of LeadingAge, Katie Sloan, sent a letter to HUD Secretary Carson urging him to distribute critically needed COVID-19 relief funds to Section 202 Housing for the Elderly and Section 8 Project-Based Rental Assistance senior housing providers. Funds were provided under the CARES Act but have yet to be distributed to these providers to help offset COVID related costs.

6/5/20: Cleaning and Disinfecting in Affordable Housing: LeadingAge has produced a new article that summarizes HUDs recommendations on this cleaning and disinfecting in Affordable Housing. Most of the information comes from CDC and EPA guidance. HUD does have a new two-pager on how HUD multifamily housing owners should dispose of medical waste. The article also links to the recording of a HUD disinfection webinar.

6/5/20: Nursing Home Payment Project for Nebraska Department of Health and Human Services: The June 4, 2020 presentation is now available at http://dhhs.ne.gov/Pages/Nursing-Home-Payment-Project.aspx

6/3/20: Long-Term Care Testing Plan- UPDATE: We heard more today during our member call with DHHS and the National Guard about testing. DHHS is planning to do a Pilot Project that starts with testing of all staff in NF and AL (or IL if co-located). Emails should be coming to providers yet this week. Testing kits will be provided by DHHS, PPE by local LHDs, and facilities can do on-site testing of their own staff. There will also be options, if needed, for assistance with testing by the Nebraska National Guard or through Test Nebraska locations. If you have a plan in place to facilitate testing already, the advice from DHHS was to move ahead with your testing. The goal is to have all facilities in Douglas and Lancaster counties tested by the end of June. The timing of the roll out for other counties is not yet known.

IF there are facilities with known positives at the time of testing, there is the possibility that residents will also be tested at that time. There is still more to come on this subject. If you are a provider in Douglas or Lancaster county, you should start getting your staff listings put together. This includes all staff. DHHS will be reaching out soon. Participation in this testing is not mandatory, but a baseline is necessary to begin moving through the phases of reopening.

6/3/20: New CMS Enforcement Memo Focuses on Infection Control: On Monday evening, CMS put out a memo (QSO-20-31-all), that includes updates on survey activities, enhanced infection control related enforcement, and quality improvement activities in nursing homes.

CMS is anticipating that every nursing facility in the country will have an survey before the end of July 2020. State survey agencies unable to complete all surveys by the deadline will have to submit a corrective action plan to CMS or face a 10% reduction in the State's CARES funding. There will also be on-site infection control surveys for:

Nursing homes with cumulative confirmed cases at 10% of bed capacity;
Nursing homes with cumulative confirmed and suspected cases at 20% of bed capacity;
Nursing homes with 10 or more deaths reported due to COVID-19.

State survey agencies will be expected to increase infection control surveys significantly or risk losing CARES funding provided to the State.

If you have not yet had your infection control survey OR you meet one of the on-site infection control survey requirements, you should be sure to get your Infection Control plan in order quickly! Here are some good resources to help you.

CMS provided an infection control survey tool in QSO-20-29-NH.
LeadingAge provided a supplemental survey tool and checklist.
The QIOs provide weekly infection control trainings.

CMS has indicated the the most frequent citations in infection control surveys have been related to hand hygiene and PPE use. LeadingAge has put together a VERY helpful document on this. A very worthwhile and succinct read.

According to the most recent CMS information for Nebraska from the end of May 2020, about 24.4% of nursing facilities in Nebraska had been surveyed.

If you are interested in data, here is the CMS Nursing Home COVID-19 data by State as of June 1, 2020.

Nebraska specific data related to COVID-19 positive staff, residents, and facilities as of 6/3/2020:

Facility Type	Resident	Death	Staff
Skilled Nursing/Nursing Facilities (SNF/NF)	381	68	290
Assisted Living (ALF)	115	19	110
Total	496	87	400


Numbers of Residents with COVID-19 Positive Status	496
Number of COVID-19 Related Deaths (validated count only)	87
Numbers of Staff with COVID-19 Positive Status	400
Total Number of Facilities Affected by COVID-19	114
Facilities Where only Resident(s) Tested Positive for COVID-19	5
Facilities Where only Staff Tested Positive for COVID-19	72
Facilities Where both Resident and Staff Tested Positive for COVID-19	37

6/3/20: Facility Care slides for June 3, 2020 call

6/2/20: Handouts for National Guard Testing Demonstration (For the June 3rd call): Captain Lisa Brand sent the following link to videos on the UNMC website that demonstrate the nasal swab technique. She is not going to show the videos during the webinar, but asked that we share the link with members so they can view on their own. There are no other handouts at this time. Please share the link with appropriate staff within your organization. https://www.unmc.edu/iexcel/visualization/content-development/covid-19.html

6/1/20: Long-Term Care Testing Plan- UPDATE: If you were able to be on the member call with Dr. Anthone and Dr. Ashraf last Friday, you heard that Nebraska was in the process of implementing a testing plan for Long-Term Care. In a call today, we were provided some additional information about next steps.

WHAT WE KNOW:

DHHS has asked that IF you are an NF or AL (or IL if co-located with an NF or AL) and you are in Lancaster or Douglas County, please start getting together your staff listing as soon as possible. There will be more information coming out on where to submit this information in the next few days.

WHAT SEEMS TO BE PART OF THE PLAN:

Testing will be focused on staff in long-term care facilities (NF and AL and IL IF co-located);
Testing will be targeted, to begin with, in counties with higher incidence of positives and then by actual staff or resident positives;
The staff baseline testing will likely be accomplished through Test Nebraska;
Testing can be accomplished for AL or IL by National Guard, if needed;
Facilities may be given an opportunity to conduct testing themselves and submit test media to Test Nebraska for processing-there will be more detail on this when available.

MORE to come on this subject, but the most important part of the message this evening is IF you are a LTC provider in Lancaster or Douglas County, get your staff listing together as you will be receiving a request for it from DHHS soon.

6/1/20: National Guard Testing Demonstration: Our Wednesday Member call with Connie Vogt will be a little different this week. We will be joined by representatives from the National Guard, including Captain Lisa Brand, who will be covering the COVID-19 testing process in an effort to help facilitate LTC testing in-house. You will also have an opportunity to ask more detailed testing questions.

Wednesday, June 3, 2020 @ 10:00 a.m. CT
Join: https://zoom.us/j/96222516275
Or call: 669-900-9128
Webinar ID: 962 2251 6275

6/1/20: New CMS Enforcement Memo: This evening, CMS put out a memo that includes survey activities, enhanced infection control related enforcement, and quality improvement activities in nursing homes.

LeadingAge national released a statement right away, with Katie Smith Sloan saying "today's data are a grim reminder of a slow motion tragedy that could have been averted if our federal and state governments had stepped up to provide leadership, coordination and funds that nursing homes need to save lives." CMS will begin posting the still incomplete data to Nursing Home Compare this Thursday and update it monthly.

6/1/20: Update on Provider Relief Funds: Today HHS published FAQs related to Provider Relief Funds. Unfortunately, the FAQs do not provide any additional specific direction on whether providers must attest to the General Distribution Funds they have received by June 3 or 90 days after receiving the payment. HHS did slightly change the language on the website related to the June 3rd deadline to imply that providers who did not receive a second payment from the $50B General Distribution must submit their attestation to HHS through the Attestation Portal AND financial information through the General Distribution Portal by June 3 to remain eligible for the 2nd payment. On this basis, LeadingAge is advising all Medicare providers who did not receive a second payment from the $50B General Distribution tranche to submit their attestation and financial information by Wednesday, June 3.

LeadingAge continues to obtain additional clarification from HHS on these issues and will share additional information if/when it becomes available.

5/29/20: Long-Term Care COVID-19 Response Planning Tool: Today (Friday) the Nebraska Department of Health and Human Services (DHHS) distributed the tool that they have developed for Long-Term Care COVID-19 response planning.

All facilities are expected to complete a COVID-19 response plan by June 22, 2020. Upon completion of the facility's plan:

Keep a copy of the plan with your facility's Emergency Preparedness Plan.
Make your plan available at the request of your local health department or DHHS.
Send an email notification of the completion including your facility name and license number to DHHS.HealthCareFacilities@nebraska.gov.
It is suggested to review CDC recommendations and information regarding COVID-19 on a regular basis, e.g., monthly, and continue to update your plan as more information is learned about COVID-19 and additional best practices become available.

If facilities need time beyond June 22nd to complete their plan, contact the DHHS Healthcare Facilities email to request an extension.

As you plan for and consider steps as restrictions loosen, LeadingAge has posted a new QuickCast in the LeadingAge Learning Hub, Reopening Considerations for Nursing Homes. The QuickCast features Janine Finck-Boyle and Jody Eyigor reviewing guidance from CMS on reopening nursing homes and the important factors nursing homes should consider in less than 20 minutes. This QuickCast is free to LeadingAge members and non-members.

5/29/20: Paycheck Protection Program Guidance: Federal guidance has been issued related to the Paycheck Protection Program. The guidance includes details on the process/timeline for securing forgiveness, how to schedule payroll costs within the loan period, aspects of non-payroll costs allowed in the loan, and how certain scenarios should be factored in to provider applications.

5/29/20: Nebraska Plans for CARES Funding: On Wednesday Governor Ricketts unveiled how the State of Nebraska plans to use federal coronavirus funds to get Nebraska growing. Nebraska is receiving $1.25 billion through the CARES Act to aid coronavirus relief efforts. The Governor outlined the main priorities for these funds which include: 1) stabilizing businesses and livestock producers; 2) supporting community institutions to meet critical needs such as food security, shelter, and mental health care; reimbursing state and local governments for coronavirus-related expenses; and 3) shoring up the State's Unemployment Insurance Trust Fund and potential General Fund budget flexibility.

Including the $1.25 billion provided through the Coronavirus Relief Fund, Nebraska has received over $10 billion in federal coronavirus assistance that have gone toward things such as public health initiatives, the provision of health care, small-business payroll protection. The Governor indicated that roughly $10.8 billion has come to Nebraska from federal coronavirus relief programs (through May 19th) and economic impact payments (through May 22nd). For a detailed breakdown of federal coronavirus funding in Nebraska, including the State's plan to allocate the $1.084 billion at its discretion, click here.

LeadingAge Nebraska has been advocating for funding to be set aside specifically for long-term care provider rates from these funds. It appears that while there will be around $40 million made available to a variety of provider types and non-profits, the funds will likely come through grant application for specific needs. More information to come on this as it becomes available.

5/27/20: Slides for Wednesday 10:00am weekly call with DHHS representatives.

5/27/20: Provider Relief Fund Attestation Deadlines Extended into July: HHS announced late in the day last Friday (5/22) that it was changing and extending the attestation deadline again. The change includes giving providers 90 days from receiving a Provider Relief Fund payment to attest to the terms and conditions. Providers who received their first payment on April 10 would now have until July 9, April 24th payments deadline will now be July 23 and May 22 payments (the recent SNF-only targeted distribution) will be August 20. Read more...

5/27/20: HUD Guidance Allows Electronic Signatures and Documents: HUD finalized guidance to allow HUD-assisted senior housing communities to use electronic signatures and documents due to COVID-19. This was done to help communities limit virus exposure for both staff and residents. When adopting electronic file policies, housing providers need to comply with federal standards, including reasonable accommodations under the ADA and federal privacy/security requirements outlined in the Notice, as well as state and local requirements for file transmission and storage. LeadingAge has pulled together this summary.

5/27/20: CDC Guidance for Travelers: Summer usually means vacations. How should staff be handled after returning from a vacation or travel? CDC Guidance says that international travelers should be excluded from work and self-quarantine for 14 days upon return. CDC has not provided similar guidance on self-quarantine and domestic travel, but cautions that some states may require it. CDC also recommends avoiding cruise ship travel at this time. CMS has not weighed in on this.

5/27/20: Nebraska ICAP Call Join the Nebraska ICAP team for the Weekly Long-Term Care call Thursday, May 27 at 12:00 (CT)

Join via Zoom: https://zoom.us/j/183449940 Or call: (346) 248 7799 Webinar ID: 183 449 940

5/27/20: Member Weekly Update Call: COVID-19 weekly member connections via Zoom on Fridays at 11:00 a.m. CT. As schedules permit, Special Guests Governor Pete Ricketts, Dr. Gary Anthone, and Dr. Salman Ashraf will also participate and provide state updates on the virus. Time will be allotted for discussion and questions.

Join via Zoom: https://zoom.us/j/291925920 Or call: (346) 248-7799 Webinar ID: 291 925 920

5/27/20: CMS Call- FULL: Establishing an Infection Prevention Program, and conducting ongoing Infection Surveillance in the Nursing Home May 28th at 3pm CT. **As of Wednesday evening this event has reached capacity for registration. If you would like a copy of the recording or the slides reach out to: dvacsupport@thebizzellgroup.com

5/27/20: Leadership Summit Cancelled: The LeadingAge 2020 Leadership Summit that was scheduled for August 10-12 in Washington, D.C. has been cancelled. LeadingAge national is planning for a series of online learning events. If you registered for the 2020 Leadership Summit will be contacted directly regarding their registration fees.

5/22/20: HHS Announces More Funding For Nursing Homes: On Friday 5/22/20 HHS announced the distribution of nearly $4.9 billion of Provider Relief Funds to nursing homes. It is anticipated that every certified nursing home in the country received a payment today, including 333 that serve only Medicaid beneficiaries. LeadingAge has also updated their updated the Provider Relief Fund Backgrounder/FAQ through today. Read MORE....

5/22/20: Action Alert! Relief for Affordable Senior Housing: As Congress debates the next COVID-19 response package, House offices need to hear your support for a new affordable senior housing relief bill. The bill, the Emergency Housing Assistance for Older Adults Act of 2020 (H.R. 6873), provides $1.2 billion for COVID-19 relief for HUD-assisted senior housing.

5/22/20: OSHA Issues New Interim Enforcement Response Plan and Guidance for COVID-19: The Occupational Health and Safety Administration (OSHA) recently issued an updated interim enforcement response plan for dealing with workplace investigations during the COVID-19 pandemic. In addition, OSHA released revised enforcement guidance for recording cases of Coronavirus Disease 2019 (COVID-19). These two requirements go into effect on May 26th and replace the previous interim enforcement response plan and recordkeeping guidance. OSHA also posted an alert on COVID-19 Guidance for Nursing Home and Long-Term Care Workers. Read the Analysis by LeadingAge.

5/20/20: CDC Guidance: CDC has updated guidance to nursing homes since CMS's new recommendations on reopening were released on May 18. The CDC guidance includes Testing Guidance for Nursing Homes, Performing Facility-Wide SARS-COV Testing in Nursing Homes and an updated Preparing for COVID-19 in Nursing Homes. There will be more information on these in the next few days.

5/20/20: NHSN Reporting: In our call today with Connie Vogt of DHHS, it was confirmed that a number of facilities are awaiting next steps from CDC before they are able to get through the NHSN registration process. Providers have until May 24 to report. If you are still waiting to report, please keep all of your emails or notes with CDC regarding the NHSN and keep trying. For assistance you can also contact Margaret Drake with NE DHHS ICAP group at margaret.drake@nebraska.gov.

5/18/20: CMS Reopening Guidelines for Nursing Homes: Early this evening CMS issued QSO 20-30-NH outlining Nursing Home Reopening Guidelines. The memo follows the phases of the White House's Opening Up America Again guidelines and describes the activities, services and survey activity that states may implement in each phase. The plan assigns to states the responsibility to determine how nursing homes progress through the phases of reopening. Last week, Nebraska DHHS announced that they are working on a tool to assist long-term care providers with planning for re-opening, which will be incorporated as a part of the required Emergency Preparedness Plan. The CMS memo includes a recommendation that nursing homes have testing plans in place for a baseline testing for every resident and staff member. Staff members would be tested weekly, as would be any others who are in the building on a regular basis, such as volunteers. Nursing homes are required to have screening protocols, arrangements with labs to process tests, and written procedures for residents or staff who decline to be tested or are unable to be tested.

The plan is also dependent on the number of positive tests in the area, assurance of adequate staffing as well as adequate PPE. These requirements seem difficult to attain given the current issues with PPE and testing availability and the associated costs. Here are the FAQs that CMS issued to accompany the memo and here is a LeadingAge article with an overview of the memo.

LeadingAge issued a statement on the CMS memo within an hour or so of its release, pointing out that the CMS Guidance fails to address the on-going need of nursing homes for tests and PPE.

5/18/20: SBA Loan Forgiveness Application: The Small Business Administration released the SBA loan forgiveness application over the weekend. Lenders will most likely have the application included on their own websites. Borrowers will need to fill out the application with their lender to get their loan principal forgiven. More information will follow as it becomes available.

5/18/20: NHSN Reporting: Yesterday marked the first day that CDC NHSN COVID-19 LTC Module reporting was required by CMS. Providers have until May 24 until CMS will implement enforcement remedies. If you are still awaiting something in order to report, please email me at jenifer.acierno@leadingagene.org and cc: Connie Vogt at DHHS at DHHS.HealthCareFacilities@nebraska.gov on the note. The DHHS is team is tracking those who still have outstanding issues that are preventing reporting. I know that a number of you have already reached out and received responses from Connie.

5/15/20: Nursing Home Commission Invites Nominations: CMS issued a press release last night (5/14) announcing that their contractor would convene the new independent Coronavirus Commission for Safety and Quality in Nursing Homes. The Commission is charged with conducting a comprehensive assessment of the nursing home response to the COVID-19 pandemic. The press release links to the nomination form. You can nominate yourself or someone else, but an organization can only nominate one person. There is a one week nomination period that ends on May 22. The Commission will start its work in June and finish by September 1.

5/15/20: SBA and Housing Providers: A reminder that the SBA has extended their safe harbor deadline to return PPP loans in "good faith." The original May 7th deadline was first extended to May 14th, now to May 18th. LeadingAge continues to urge the SBA to clarify loan program eligibility for non-profit housing providers. See the last FAQ item for the safe harbor extension.

5/15/20: Midlands Voices: Let's meet the needs of elderly Nebraskans in long-term care: By Jenifer Acierno and Heath Boddy; See this letter to the editor in the Omaha World Herald related to the needs of elderly Nebraskans.

5/13/20: CMS Issues Nursing Homes Best Practices Toolkit to Combat COVID-19: Today (5/13) 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 catalog 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.

SHOUT OUT to Vicky Hendricks and her team at Callaway Good Life Center for their work in developing the red, yellow, and green zone cohorting. See page 23 of the toolkit for a reference to this practice from Nebraska ICAP at Callaway Good Life Center.

5/13/20: Paycheck Protection Program Guidance on Certification of Need: New Information, Unanswered Questions: FAQ guidance from the Department of the Treasury and the Small Business Administration provides new information on Paycheck Protection Program borrowers on the certification of need for loan funds. Read MORE...

5/13/20: CDC Guidance on Memory Care: CDC released new guidance yesterday on COVID-19 considerations for memory care. This information and guidance can be useful for work with all residents with cognitive impairments, regardless of the level of care or placement on a designated memory care unit. While much of this information is standard practice for working with those with cognitive impairments, one interesting recommendation is that CDC recommends that staff working on a memory care unit wear eye protection and N95 respirators at all times when on the unit to minimize risk of exposure from ill, wandering residents. CDC also recommends maintaining consistency in staff, activities, and environments as much as possible, including continuing to allow safe physical activity such as walking the unit or walks outdoors.

5/13/20: NHSN Reporting & COVID Module Training: I have been hearing from many of you about difficulties getting registered for NHSN. I want to assure you that you are not alone. A few options that might help if you have attempted registration and are still having difficulty: 1) Email nhsn@cdc.gov with technical questions or to check on status; 2) Send an email to Margaret Drake with the ICAP team. Margaret has a great deal of experience working with NHSN. Her email is margaret.drake@nebraska.gov. She may be able to give you pointers or send you to the right contacts.

5/13/20: Application Deadline for CMP Grant Funds for Communicative Technology: Nebraska providers of Nursing Facilities have the opportunity to apply for communicative technology through a CMS program funded with state CMP dollars. Nebraska is making $210,000 available to nursing facility providers for technology, accessories, and cleaning products to help connect residents with families, healthcare providers, and others.

In an effort to facilitate options to connect residents, CMS, through QSO 20-28-NH, has provided an opportunity for providers to submit an application for technology funding to the State Medicaid agency for CMP funds to be used to purchase technology for residents. For specific information from see FAQ 3 in the QSO memo above.

Please see the following for more information, including the Application, FAQs, and Nebraska Guidance:

If you plan to apply, do so quickly. Applications should be submitted to Dawn Sybrant at Nebraska Medicaid. Her email is dawn.sybrant@nebraska.gov. The DEADLINE FOR APPLICATIONS IS MAY 25, 2020. DHHS plans to start approving requests on June 1, 2020.

5/13/20: Additional CMS Waivers from May 11: In the last update I provided information related to additional waivers issued by CMS. Here is the CMS fact sheet on the waivers AND the LeadingAge resource.

5/13/20: Supporting Mental & Emotional Health and Well-being: In an effort to meet the needs of our long-term care providers and residents, please see the following resources made available by the DHHS, Division of Behavior Health.

5/13/20: CMS Infection Control Surveys: Based on infection control surveys that are still being done, CMS has noted the importance to follow the CMS and CDC guidelines. A few key issues that they are seeing in those surveys are as follows:

Hand hygiene
Appropriate use of PPE (not related to PPE supply)
Timely notification to physicians regarding change in condition
Failure to cohort (not related to ability to cohort)

5/13/20: How to Survive the Pandemic with An Unbroken Spirit: Actions to Take Right Now to Stay Strong and Focused

Discover how to successfully manage your mental health needs while caring for COVID-19 patients. Nurses are tough but COVID-19 is challenging their toughness in new and unique ways.

This webinar, part of the ANA COVID-19 webinar series, will help you survive this bleak and distressing time. FREE, On-Demand Webinar for ALL Nurses.

5/12/20: BLANKET WAIVERS From Doug Hohbein, CLSSEGB, Assistant State Fire Marshal: Good afternoon, I'm sure you are aware, but I want to reiterate information found in a document provided by CMS recently. CMS is granting blanket waivers for several Life Safety items including Inspection, Testing and Maintenance (ITM), Fire Drills and alcohol-based hand rub dispensers. These items are specified starting on page 25 of the attached document (Summary).

See the attached CMS Blanket Waiver Memo for details on the ITM waivers.

The bottom line is that CMS is granting waivers retroactive to March 1, 2020 for:

Many ITM requirements
Replaces typical fire drills with a training program
Allows increased numbers of hand sanitizer dispensers

I hope this information helps. Let me know if you have any questions or comments.

Thanks, Doug Hohbein, CLSSEGB, Assistant State Fire Marshal

5/11/20: CMS Announces New Waivers - Read more

5/11/20: Questions About Telehealth and Waivers? See this COVID-19 Telehealth Service Changes from the USDA.

5/11/20: CDC resources from Nimalie Stone: Nimalie Stone, lead of the LTC team within CDC's Division of Healthcare Quality Promotion, spoke on our afternoon update call on Thursday (May 7). She has shared a list of CDC resources that are relevant to LeadingAge members. The list includes an infection preventionist training course that offers approximately 20 CE hours upon completion and live Q and A sessions on COVID and LTC facilities on May 12 and May 14 (space is limited).

5/11/20: HHS Issues New Provider Relief FAQ and says More Relief Coming: The U.S. Department of Health and Human Services (HHS) issued an updated Frequently Asked Questions (FAQ) document late Friday, May 8 which includes two new pages of information and clarifications regarding the Provider Relief Fund and in a meeting with HHS Deputy Secretary Eric Hargan told LeadingAge CEO Katie Smith Sloan that additional relief is coming. Read more...

Last week HHS announced that it is extending the time providers have to attest to the terms and conditions for payments received from the Provider Relief Funds. Providers will now have 45 days (previously 30 days) to make a decision about whether to keep the payments received and agree to the terms and conditions. No additional FAQs were provided as part of this announcement so questions remain. Leading Age continues to seek additional information to ensure that providers have the answers they need to make a good decision on attestation by the May 24 deadline.

There is an ever-growing set of FAQs related to Provider Relief Fund payments has been updated. Some highlights of the new FAQs:

"Generally, HHS does not intend to recoup funds as long as a provider's lost revenue and increased expenses exceed the amount of Provider Relief funding a provider received." HHS still reminds recipients that they reserve the right to audit.
Providers are eligible for the fund if they provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. "HHS broadly views every patient as a possible case of COVID-19."
Per the terms and conditions, every recipient of PRF payments must submit documents to substantiate that the funds were used for increased healthcare-related expenses or losses from other sources that were not otherwise reimbursed.
Reporting requirements begin for the calendar quarter ending June 30, 2020. What that documentation looks like is yet to be determined.

5/8/20: NHSN Reporting, Transparency Reporting & COVID Module Training: NHSN Reporting continues to be the topic of conversation. Take a look at the memo requiring the reporting (QSO 20-26-NH), the memo with the Q&As (QSO 20-29-NH), and the LeadingAge analysis. The first report to CDC needs to be submitted by 11:59pm on May 17. CMS will begin publicly reporting data on May 31. CMS has unveiled 2 new F-tags for these reporting requirements and failure to report to CDC will be met with civil money penalties. In addition to reporting, nursing homes should use the updated infection control survey tool to complete self-assessments. Recall that they will be asked for these self-assessments on survey. LeadingAge will be submitting comments on this rule.

Providers who are not currently registered in NHSN should register. If you are having difficulty reg. If you are not a Medicare or Medicaid certified provider the federal CDC/CMS reporting is not required. You are required to report once a week regardless of whether you have any positives or not. CMS will be pulling compliance information by CCN, so make sure you are reporting weekly regardless. Corporate organizations can report on behalf of individual locations. You can also email CDC at the nhsn@cdc.org with any technical issues. The slides for the COVID-19 Module Overview for LTCFs - April 2020 and COVID-19 Module Enrollment Guidance for LTCFs - April 2020 are available and there are additional training sessions scheduled. See the webinar information that was posted on May 6th below.

5/7/20: NHSN Reporting Date Extended: Last night CMS issued a new Memo & FAQ document, (QSO-20-29-NF) on National Healthcare Safety Network enrollment and reporting. The start date for reporting has been pushed out to MAY 17. CMS urges providers who are not currently registered in NHSN to begin the registration process as soon as possible. If you have difficulty registering send an email to nhsn@cdc.org and include "LTCF" in the subject line. The registration process involves some email exchange, so make sure that emails from NHSN are not blocked. If you are not a Medicare or Medicaid certified provider this is not required, but you should look to state reporting requirements. CMS indicates that 3,000 nursing homes are already enrolled and that since the new reporting requirement came into play and additional 600 providers have made it through the enrollment process. A total of 700 have started reporting on the LTC module.

The FAQ that is a part of QSO 20-29-NF indicates that 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 fail to begin reporting after the third week (by 11:59 p.m. on May 31st) will receive a warning letter reminding them to begin reporting the required information to CDC. For facilities that have not started reporting in the NHSN system by 11:59 p.m. on June 7th, ending the fourth week of reporting, CMS will impose a per day (PD) civil money penalty (CMP) of $1,000 for one day 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.

5/6/20: NHSN Reporting, COVID Module Training: Providers who are not currently registered in NHSN should try to register. Some of you have indicated that you are having difficulty registering. CDC has provided some training options The registration process involves some email exchange, so make sure that emails from NHSN are not blocked. If you are not a Medicare or Medicaid certified provider this is not required, but you should look to state reporting requirements. If you are unable to register with NHSN by May 8, 2020 please send a note to jenifer.acierno@leadingagene.org. Connie Vogt has asked the associations to collect information on registration issues and share them with her. You can also email CDC at the nhsn@cdc.org with any technical issues. The slides for the COVID-19 Module Overview for LTCFs - April 2020 and COVID-19 Module Enrollment Guidance for LTCFs - April 2020 are available and there are additional training sessions scheduled:

Topic: LTCFs COVID-19 Live Q & A Session for Module and Enrollment Specific Questions, Pt. 2
When: May 7, 2020
Time: 2:00 PM ET

Space is limited. Register in advance for this meeting:
https://cdc.zoomgov.com/meeting/register/vJItf-Copz4tHlbYy9mQxiqPKuDNG-CdvcI

After registering, you will receive a confirmation email containing information about joining the meeting.

Topic: LTCFs COVID-19 Live Q & A Session Pt. 3
When: May 12, 2020
Time: 1:00 PM ET

Space is limited. Register in advance for this meeting:
https://cdc.zoomgov.com/meeting/register/vJItfu-pqTkvH2MsV2ABgrYt5vZXOtUN8Yc

After registering, you will receive a confirmation email containing information about joining the meeting.

Topic: LTCFs COVID-19 Live Q & A Session Pt. 4
When: May 14, 2020
Time: 2:00 PM ET

Space is limited. Register in advance for this meeting:
https://cdc.zoomgov.com/meeting/register/vJIscu2srDsiEglkcW2MxFjkBTLJZ-KwqDg

After registering, you will receive a confirmation email containing information about joining the meeting.

5/6/20: Identification of a COVID Case in Your Facility? Now What? If you need to know next steps on what to do if you have a COVID+ resident, see this ICAP/ICAR Toolkit on helpful next steps on what you need to do and who you need to contact.

5/6/20: Lodging Resources Available for Healthcare Workers: If you are a healthcare worker, correctional officer, or first responder and you need a place to stay related to the COVID-19 related work that you are doing, the State is providing options. If you can not return home because you have someone living with you who is elderly, considered high-risk, or you are working away from home, check out the DHHS website where you can find more information and fill out this Accommodation Request Form.

5/6/20: PPE Shortages: LeadingAge national is hearing from members across the nation about the PPE Shortages that are being experienced and urgently needs a snapshot of the current state of personal protective equipment and testing among our membership. Please answer these fast questions to help us assure the reality on the ground is reflected clearly in the media. Your input is critical as we continue to shape the narrative in our fight against the pandemic.

5/6/20: CMP Funds for Communicative Technology: On Monday you received information related to the CMP funds being made available to providers for Communicative Technology. CMS, through QSO 20-28-NH, has provided an opportunity for providers to submit an application for technology funding to the State Medicaid agency for CMP funds to be used to purchase technology for residents. For specific information from see FAQ 3 in the QSO memo above. Today, Nebraska DHHS made the CMP Announcement link for communicative technology available on the DHHS website. Applications should be submitted to dawn.sybrant@nebraska.gov. Limited CMP funds ($210,000) are available for this project.

5/5/20: Documents for May 6th call with Connie Vogt with DHHS:

5/5/20: CMS Interim Final Rule: The long-awaited Medicare and Medicaid Interim Final Rule that includes reporting requirements for the SNF Quality Reporting Program was released the end of last week. It is currently in the public inspection phase and schedule to be published in the Federal Register on Friday, May 8. The effective date of reporting coincides with the date of publication, so be ready to report beginning May 8. READ MORE...

Providers who are not currently registered in NHSN should register. The registration process involves some email exchange, so make sure that emails from NHSN are not blocked. If you are not a Medicare or Medicaid certified provider this is not required, but you should look to your state reporting requirements. There is a training scheduled by CDC tomorrow to help:

COVID-19 Module Overview for Long-term Care Facilities Webinar

When: May 5, 2020
Time: 3:00 - 4:30 PM ET; 2:00-3:30 CT
Please click the link below to join the webinar:
https://cdc.zoomgov.com/j/1602548824?pwd=ZjNVcEJib0tvZzB4UlpOZjQva0t0UT09
Password: 339263

REMEMBER: The rule also adds a new requirement that facilities inform residents, their representatives, and families of those residing in facilities of confirmed or suspected COVID-19 cases in the facility among residents and staff. Facilities must provide communication by 5 p.m. the next calendar day following the occurrence of either:

A single confirmed infection of COVID-19; OR
Three or more residents or staff with new-onset of respiratory symptoms that occur within 72 hours of each other.

Furthermore, facilities must inform residents, their representatives and families by 5 p.m. the next calendar day following the subsequent occurrence of either:

Each time a confirmed infection of COVID-19 is identified; OR
Whenever 3 or more residents or staff with new onset of respiratory symptoms that occur within 72 hours of each other.

Information must be reported in accordance with existing privacy regulations and statute, and must not include Personally Identifiable Information (PII). Facilities must include information on mitigating actions implemented to prevent or reduce the risk of transmission, including if normal operations in the nursing home will be altered. For purposes of this reporting requirement, facilities are not expected to make individual telephone calls. Instead, facilities can use paper notification, listservs, website postings, and/or recorded telephone messages to make information easily available to all residents, their representatives, and families.

5/5/20: CDC Return to Work Guidance Updated: This weekend, the CDC amended their criteria for healthcare personnel returnin g to work. The term "non-test-based strategy" was changed to "symptom-based-strategy" for those with symptoms and the "time-based-strategy" for those without symptoms AND the duration of exclusion from work was extended to at least 10 days since symptoms first appeared, as opposed to 7 days.

5/5/20: UV Disinfection Equipment Location and Contact Information: If you are running short on masks and are close to one of these locations, you can contact them to get your masks disinfected HERE. The state has six locations available and a number of them have indicated capacity to disinfect additional masks.

5/5/20: PPE Shortages: On Friday, I shared this on-line form provided by DHHS to place your PPE order requests. I have heard from a number of members that what you are receiving is far less than what you are ordering each week. We are trying to get to the bottom of this. While we know that there may be some limitations on PPE, in some areas of the state they seem to be more significant than others. If you ARE experiencing shortages and you ARE placing weekly orders on-line, please email me at jenifer.acierno@leadingagene.org with the information on what you ordered the past 2-3 weeks AND what you received. Please also include who is overseeing the distribution in your area (ex: LHD, hospital, Health Care Coalition). I am working with a group from UNMC/Nebraska Medicine and DHHS to try to determine where the problem is arising related to PPE distribution and any information that you can provide is helpful. Thanks to those who have already provided this information!

5/5/20: CMP Funds for Communicative Technology: In an email earlier this evening you received information related to the CMP funds being made available to providers for Communicative Technology. CMS, through QSO 20-28-NH, has provided an opportunity for providers to submit an application for technology funding to the State Medicaid agency for CMP funds to be used to purchase technology for residents. For specific information from see FAQ 3 in the QSO memo above.

Please see the following for more information, including the Application, FAQs, and Nebraska Guidance:

If you plan to apply, do so quickly. Nebraska has a limited about (around $200,000) of CMP funds available for this project. A variety of communicative technology can be purchased through this grant. You may already have a technology base in place that you would like to add to or maybe you are interested in trying something new.

5/5/20: Dementia and COVID-19: Insights from the Field: Many of you have voiced concerns related to COVID-19 and residents with dementia and the associated challenges. LeadingAge provides this FREE 13-minute QuickCast to share ideas and insights garnered from providers and collaborators who are supporting people with dementia amidst COVID-19. Available to LeadingAge members AND non-members.

5/5/20: HUD May 4 Presentation: Cleaning and Disinfecting of Indoor Spaces: If you are interested in hearing more about the HUD presentation on clearing and disinfecting indoor places and missed the presentation. Please see the associated Power Point.

5/5/20: Rural Housing to Launch Service Coordination: For more information on Service Coordination becoming available to senior and disabled communities read more HERE.

5/5/20: LeadingAge Advocates Strongly for Members: If you would like to read about some of the advocacy happening by LeadingAge for our Seniors, read this letter to Secretary Azar with HHS. LeadingAge hears member requests for additional funding for Medicaid providers related to Nursing Facility, Home Health, Hospice, PACE and hot spot nursing facility providers and is continuing to take action.

5/5/20: Partners in Preparedness Project: If you were able to join us for the joint LeadingAge Nebraska and NHCA call last Friday, you heard about an exciting resource that will be coming on-line for Nursing Facilities and Critical Access Hospitals. The Partners in Preparedness Project aims to serve a critical need in the COVID-19 response by partnering experienced mentors with key personnel in critical access hospitals and long-term care facilities across Nebraska. HERE is the link to Friday's Power Point, which includes contact information for Leslie Scofield with UNMC and information on how to submit request to participate. This assistance is FREE to participants, voluntary, and not related to survey. Feel free to contact Jenifer with any questions as well.

5/1/20: CMS Interim Final Rule: The long-awaited Medicare and Medicaid Interim Final Rule that includes reporting requirements for the SNF Quality Reporting Program was released last yesterday. It will likely be published in the Federal Register in the next few days. Reporting requirements are effective the date the Interim Final Rule is published in the Federal Register. The reporting must include: suspected and confirmed COVID-19 infections among residents and staff; total COVID-19 deaths among residents and staff; PPE and hand hygiene supplies in the facility; ventilator capacity and supply; resident beds and census; access to COVID-19 testing in the facility; and staffing shortages. The information will be submitted no less than weekly through the CDC National Healthcare Safety Network. The rule includes many other provisions related to home health, DME, and quality reporting. More detailed analyses and related documents will be coming out in the next few days.

Providers who are not currently registered in NHSN should register. The registration process involves some email exchange, so make sure that emails from NHSN are not blocked. If you are not a Medicare or Medicaid certified provider this is not required, but you should look to your state reporting requirements. There are two additional training next week:

COVID-19 Module for Long-term Care Facilities Enrollment Guidance
When: May 4, 2020
Time: 2:00 - 3:30 PM ET; 1:00-2:30 CT
Password: 385978
JOIN THE WEBINAR

COVID-19 Module Overview for Long-term Care Facilities
When: May 5, 2020
Time: 3:00 - 4:30 PM ET; 2:00-3:30 CT
Password: 339263
JOIN THE WEBINAR

The rule also adds a new requirement that facilities inform residents, their representatives, and families of those residing in facilities of confirmed or suspected COVID-19 cases in the facility among residents and staff. Facilities must provide communication by 5 p.m. the next calendar day following the occurrence of either:

A single confirmed infection of COVID-19; OR
Three or more residents or staff with new-onset of respiratory symptoms that occur within 72 hours of each other.

Furthermore, facilities must inform residents, their representatives and families by 5 p.m. the next calendar day following the subsequent occurrence of either:

Each time a confirmed infection of COVID-19 is identified; OR
Whenever 3 or more residents or staff with new onset of respiratory symptoms that occur within 72 hours of each other.

5/1/20: New Blanket Waivers: CMS announced new blanket waivers on the evening of April 30. The updated list includes new items can be found on the CMS website. The new waivers include specifics for skilled nursing facilities, home health, and hospice. These include narrowing QAPI to focus on infection control and adverse events, postponing in-service training requirements for aides, waiving quality reporting on discharge planning processes, and lengthening the time to provide clinical records. There are additional telehealth waivers and physical environment waivers included as well.

New blanket waivers include:

Telehealth - Expanded professionals that can furnish distant site telehealth services to include ALL who are eligible to bill Medicare for professional services. This includes PT, OT, SLP.
Audio-only telehealth - Audio only telehealth is only available for the services described by the audio-only E&M codes. Unless provided otherwise, the telehealth services must include audio and video and permit two-way, real time interactive communication.
QAPI - Narrows scope of QAPI to focus on adverse events and infection control to ensure facilities focus on aspects of care delivery most closely associated with COVID-19.
CNA in-service training - Postponing 12-hour annual in-service training requirement for nursing facilities until the end of the first full quarter after the Public Health Emergency declaration concludes.
Discharge Planning - Waives requirement to provide data like QMs to help patient select a post-acute provider. All other discharge planning requirements remain.
Clinical records - Modifies time frame to provide a resident or patient's record to 10 days for nursing facilities and home health.
Physical Environment Inspection/Testing - Modifies nursing facility ROP regulatory requirements related to physical environment maintenance to the extent necessary to permit facilities to adjust scheduled inspection, testing, and maintenance frequencies for facility and medical equipment.
Life Safety Code Inspection/Testing/Maintenance - Modifies LSC requirements to permit modification of scheduled inspection, testing, and maintenance frequencies. However, the following are NOT waived and cannot be modified:
- 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.
Waives need for outside window or outside door in every sleeping room to allow for additional temporary patient care/isolation areas.

5/1/20: LeadingAgeNE/NHCA Partners in Preparedness Project PPT

4/29/20: National Healthcare Safety Network: The CDC COVID-19 module for long-term care facilities is now available on the National Healthcare Safety Network (NHSN) system website. LeadingAge notes that the federal rule, announced by CMS on April 19, has still not been released. In the absence of rulemaking or further guidance from CMS, reporting is not yet required. We expect communication from CMS on this reporting soon. The announcement also includes links to webinars on the module and on how to enroll in NHSN. LeadingAge continues to advocate to HHS/CMS and Congress to either rescind this requirement or develop a reporting system that involves only ONE report from providers. READ MORE ...

4/29/20: New CDC LTC Frontline Staff Training Webinars: These short webinars are all published on the Key Strategies to Prepare for COVID-19 in Long-term Care Facilities (LTCFs) web page at the bottom under a "Webinar Series" section. CDC reports that these new webinars are intended to be a training tool/resource for front line long-term care staff members. Here are the direct links to each webinar:

Sparkling Surfaces - https://youtu.be/t7OH8ORr5Ig
Clean Hands - https://youtu.be/xmYMUly7qiE
Closely Monitor Residents - https://youtu.be/1ZbT1Njv6xA
Keep COVID-19 Out! https://youtu.be/7srwrF9MGdw
PPE Lessons - https://youtu.be/YYTATw9yav4

CDC Updated the following three resources:

Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
Additional Guidance for Nursing Homes and Long-Term Care Settings: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html
Preparedness Checklist for Nursing Homes and Other Long-Term Care Settings: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care-checklist.html

4/29/20: CMS Requires Medicare Advantage To Cover More Items: CMS issued an amended memorandum to MA plans last week expanding the list of services they must cover, which include coverage for COVID-19 testing, and Medicare Part A & B services provided by non-contracted providers. CMS also outlined a number of additional flexibilities they were giving plans including allowing more than a 14-day supply of Part D drugs to be dispensed to long term care facilities. READ MORE...

4/29/20: New FAQ Clarifies Some Provider Relief Fund Questions: The Department of Health and Human Services (HHS) added a new post over the weekend that now includes a new 9-page General Distribution Portal FAQ, which provides more clarity on what providers who have received general distribution funds (e.g., Medicare providers) need to do in order to keep those payments. READ MORE...

4/29/20: HUD Issues Framework for COVID-19 Oversight: As relief funds from Congress flow to various affordable housing programs, HUD's Office of Inspector General issued a COVID-19 oversight framework to guide program audits and evaluations. The framework discusses supporting older adults and maintaining operational integrity as HUD pulls back on other oversight mechanisms, including physical inspections and file reviews. HUD also issued bulletins on fraud prevention for renters and others. READ MORE ...

4/29/20: A Message From Doug Hohbein, Asst State Fire Marshal: "I have received several inquiries regarding the installation of temporary isolation barriers recently. I know many health care facilities are compelled to install such barriers for infection control. I understand this and don't want to impede these efforts, but I want to make sure safety is not forgotten.

For this reason I have created the attached document that I would like all facilities to follow so we can ensure some degree of safety is maintained during the temporary use of isolation barriers." Temporary Isolation Barrier Requirements

4/29/20: The following documents are for the April 29, 2020 call with NE DHHS representatives, Connie Vogt, Dan Taylor and Dawn Sybrant:
QSO-20-26-NH CMS Quality, Safety & Oversight Group Memo
COVID-19 Focused Survey for Nursing Homes
4/29/20 DHHS PowerPoint
Return to Work Criteria for Healthcare Workers - CDC
Strategies to Mitigate Healthcare Personnel Staffing Shortages - CDC

4/27/20: Advanced & Accelerated Payment Program for Providers Suspended: Congress appropriated $100 billion in the Coronavirus Aid, Relief, and Economic Security (CARES) Act and $75 billion through the Paycheck Protection Program and Health Care Enhancement Act for healthcare providers. HHS is distributing this money through the Provider Relief Fund, and these payments do not need to be repaid. The CARES Act Provider Relief Fund is being administered through HHS and has released $30 billion to providers, and is in the process of releasing an additional $20 billion, with more funding anticipated to be released soon. This funding will be used to support healthcare-related expenses or lost revenue attributable to the COVID-19 pandemic and to ensure uninsured Americans can get treatment for COVID-19. On April 26 the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. Beginning on April 26, 2020 CMS will not be accepting any new applications for the Advance Payment Program, and will be reevaluating all pending and new applications for Accelerated Payments. They also issued this Fact Sheet. READ MORE...

4/27/20: CMS Freezes Health Inspection Ratings and Issues FAQs: As was shared on Friday, CMS released a new memo and FAQ document, which announced a freeze to health inspection rating on Nursing Home Compare and addresses a number of questions that have come up over the last many weeks. CMS indicates that the information in this document should be used to make decisions based on:

The needs of the resident,
Actions needed to prevent transmission of COVID-19, and
The circumstances of each situation.

LeadingAge recommends that nursing homes utilize this framework in decision-making and be able to provide information for each of these considerations in justifying decisions. READ MORE..

4/24/20: Nursing Home Five Star Quality Rating System Updates, Nursing Home Staff Counts, and Frequently Asked Questions: In a recent memo to State Survey Agencies, CMS announced that the inspection domain of the Nursing Home Compare website will be held constant temporarily due to the prioritization and suspension of certain surveys, to ensure the rating system reflects fair information for consumers. In addition, CMS is releasing information that shows the average number of staff each nursing home has onsite, each day (nursing staff and total staff), and aggregated by state and nationally. Along with these announcements CMS released a list of Frequently Asked Questions to clarify certain actions the agency has taken related to visitation, surveys, waivers, and other guidance.

The Q&A included in the Memo is quite lengthy. A few key points include: 1) Surveys will continue to be suspended until further notice; 2) The Health Inspections domain on Nursing Home Compare will be frozen after next week, the Staffing and Quality measures will not be frozen, but will be assessed after the next update in July; 3) CMP funds can be used to purchase communication devices for facilities ($3k max) to help keep residents in touch with loved ones and can also be used for telehealth. Link to the Memo. Link to Five-Star Quality Rating Information.

4/24/20: Congress Passes Paycheck Protection Program and Health Care Enhancement Act: On April 23, 2020, Congress passed the Paycheck Protection Program and Health Care Enhancement Act. The Act provides $310 billion in additional funding for the Paycheck Protection Program (PPP) and $10 billion for the Economic Injury Disaster Loan (EIDL) program. It also provides additional funding for Provider Relief and for COVID-19 testing.

SBA lenders are expected to have the ability to process and submit loan applications within the next few days. Members who did not get their application in for the first round of funding are encouraged to act quickly.

4/24/20: Staffing Resource Options in Nebraska: DHHS has been working to pull together staffing assistance resources for Nebraska providers. For more information related to the Staffing Pool, contact Caryn Vincent with DHHS Division of Public Health at caryn.vincent@nebraska.gov, (402) 471-1595 or (402) 613-2377. Per the ICAP call yesterday, please provide Caryn the name of your facility, your name and contact information, and what type of staffing you need and she may be able to assist in locating resources.

4/22/20: Next Round of Provider Relief Funds Begin April 24: HHS announced Wednesday, April 22 that it will begin distributing the next round of CARES Act Provider Relief Funds and providers will begin seeing the new payments as early as Friday, April 24.

This second tranche of funding, $100B, will begin rolling into provider bank accounts starting April 24 and be distributed in accordance with this announcement, which was released this evening. According to the article $50B is for general distribution based on prior Medicare revenue. The first $30B, based on FFS billing in 2019, came out April 10/April 14. Providers with a relatively small proportion of funds coming from Medicare, such as children's hospitals, will get the remaining $20B (of the $50B). Additionally $10B will be targeted to hospitals in high outbreak areas, $10B to rural health clinics and hospitals, $400M for Indian Health Service providers, an unspecified amount for SNFs, dentists and providers that exclusively serve Medicaid beneficiaries, and an unspecified amount to reimburse providers at Medicare rates for treating uninsured COVID patients. Here's an article that explains the announcement in a bit more detail. An important thing to keep in mind is that a lot of details are unspecified.

Yesterday evening, the Senate passed the Paycheck Protection Program and Health Care Enhancement Act. This bill authorizing new funding for key programs that are important for LeadingAge members engaged fighting COVID. The Senate measure includes $300B more for the SBA Paycheck Protection Program which ran out of money last week; more than $50B for other SBA emergency loans; $75B more for the fund we call the Provider Relief Fund; and $25B for testing, with federal, state and local obligations to identify how they will implement testing. The House is expected to return on Thursday (4/23) to pass the bill.

4/22/20: CDC Clarifies Elements of Forthcoming Nursing Home Reporting Requirements: A recent call with CDC has clarified some details around forthcoming requirements that nursing homes must report information about COVID-19 directly to CDC.

As previously reported, CMS previewed new COVID-19 reporting requirements for nursing homes on April 19. These new requirements are pending rulemaking that is forthcoming. While little information is available from CMS ahead of the rulemaking, a recent call with CDC shed some light on the reporting mechanism.

Here is an article describing the technical discussion of how LTC providers will enroll and participate in the National Healthcare Safety Network. This was not a discussion of CMS policy issues, such as the frequency of reporting, retrospective reporting, and other aspects of the forthcoming CMS regulation. CDC staff did note that CMS would likely allow a grace period for providers to get up to speed on using the CDC LTC reporting system.

While we expect that providers will comply with the CMS requirement to report to CDC (when the rule comes out of CMS), LeadingAge is concurrently advocating for the rescinding of this duplicative reporting requirement or the creation of a single, universal reporting requirement that will collect one set of information that can be reported to whatever entities need it.

Information regarding the reporting mentioned above was also discussed in the Zoom call with Connie Vogt, Dawn Sybrant, and Dr. Ishrat Kamal-Ahmed. Please find the PowerPoint from the presentation; the CMS Guidance on Reporting and Transparency, QSO-26-20-NF; and the updated DHHS Reporting form. All of the attachments are included in the LeadingAge Member Portal and on the LeadingAge Nebraska home page COVID-19 Resources for Members and Non-Members.

4/22/20: QSO-20-26-NH CMS Quality, Safety & Oversight Group Memo

4/22/20: LTC Respiratory Surveillance Line List

4/22/20: LeadingAge/NHCA April 22, 2020 Powerpoint Presentation

4/22/20: Slides from Connie Vogt's 4/15/20 COVID-19 Updates presentation

4/22/20: Resident Covid-19 List - Helpful Hints

4/22/20: Facility COVID-19 List - Blank

4/20/20: CMS Announces New COVID-19 Reporting Requirements for Nursing Homes: CMS announced upcoming requirements for nursing home reporting of COVID-19 in a Quality, Safety & Oversight group memo, QSO-20-26-NH, on April 19. CMS reinforced existing requirements for reporting to state and local health departments on COVID-19 confirmed or suspected cases and clusters of respiratory illness, then announced that new requirements are forthcoming. Nursing homes will be required to additionally report information on cases and clusters directly to CDC through the National Health Safety Network (NHSN) system. CDC will publicly report this information, while using this data to support surveillance, monitor trends, and inform policy. READ MORE...

4/20/20: Considerations When Preparing for COVID-19 in Assisted Living Facilities: Assisted living facility (ALF) owners and administrators are urged to implement these recommendations to protect their residents and staff. READ MORE...

4/17/20: Provider Relief Fund Payment Resources and New Attestation Portal Launched: Yesterday (4/16/20) HHS announced that its Provider Relief Fund Attestation Portal is open. Providers who received payments from the $100 billion fund, created by the CARES law, must agree to the terms and conditions set by HHS, using the portal. If providers do not want to keep the funds because they think they may be ineligible, they must also enter the portal to inform HHS they will return the money. LeadingAge is working on developing guidance documents/things to consider related to attesting for these funds so there will be more information to follow.

In addition, HHS posted a toll-free number for providers who believe they qualify for payments but have not yet received a payment. Providers can find out the status of their payment and an estimated amount (the formula is in the HHS website). Providers can still contact HHS about the fund using the email HOSPITALCOVID19@hhs.gov.

4/17/20: CDC Telephone-based ICAR Assessments: Dr. Tierney reached out last evening (4/16/20) to ask that we share information with members regarding assistance that will be offered to Nebraska facilities from CDC to help prepare for COVID-19 in their residents. CDC will be providing telephone-based ICAR (infection control) assessments by a team of CDC epidemiologists and infection preventionists. This is non- regulatory and the results will not be shared with Nebraska DHHS. The assessment is free of charge and is an invaluable resource to help facilities to prepare for the tough challenge of containing COVID-19 in your facility. The CDC virtual preparedness mentoring sessions are for facilities that have not had COVID-19 residents and CDC will be reaching out directly to facilities to set up assessments.

4/14/20: Strategies to Mitigate Healthcare Personnel Staffing Shortages: Yesterday (4/13/20) CDC provided updated guidance related to Contingency an Crisis Capacity Strategies for healthcare facilities to consider during times of personnel staffing shortages.

Who is this for: Healthcare facilities who may be experiencing staffing shortages due to COVID-19.
What is it for: To assist healthcare facilities in mitigating healthcare personnel staffing shortages that might occur because of COVID-19.

4/14/20: HUD Issues Forbearance and Underwriting Options for MFH, Healthcare Facilities: On April 13th, HUD published three mortgagee letters with forbearance and underwriting options for all FHA approved Multifamily mortgages, Section 223(f) Multifamily Housing projects, and Section 232 Healthcare Facilities. READ MORE.