Resources are listed by date they were posted.

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

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 HomesPerforming 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 SheetREAD 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.