COVID-19 Resources for Members and Non-members

Resources are listed by date they were posted.

  • NEBRASKA ICAP CALL FOR LONG-TERM CARE, Every Thursday at noon CT: Join Dr. Maureen Tierney 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.
  • 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.

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.

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

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.

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!

6/17/20: 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 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:

  1. Testing will be focused on staff in long-term care facilities (NF and AL and IL IF co-located);
  2. Testing will be targeted, to begin with, in counties with higher incidence of positives and then by actual staff or resident positives;
  3. The staff baseline testing will likely be accomplished through Test Nebraska;
  4. Testing can be accomplished for AL or IL by National Guard, if needed;
  5. 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:

  1. "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.
  2. 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."
  3. 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.
  4. 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 returning 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. 

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. 

5/1/20: 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:

CDC Updated the following three resources:

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:

  1. The needs of the resident,
  2. Actions needed to prevent transmission of COVID-19, and
  3. 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.