*Updates are listed by date with the most recent listed first.

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.

4/13/20: Hospital to Post-Acute Care Facility Transfer- COVID-19 Assessment Tool: There are many questions related to hospital to post-acute transfer and COVID-19.  In an effort to answer some of those questions LeadingAge Nebraska took the lead in bringing together representatives from the Nebraska Hospital Association, Nebraska ICAP (special thanks to Dr. Ashraf and Kate Tyner) and NHCA.  Together, we worked to develop this COVID-19 TRANSFER ASSESSMENT TOOL. While we know it will not answer every question that comes up related to transfer, the goal is for it to be helpful and to provide a framework to answer many of your transfer questions. All providers make decisions related to transfer and receipt of residents on an individual basis, but the goal is for this document to provide some uniformity with that process.

4/10/20: CARES Act Provider Relief Fund: On March 27, 2020, the President signed the bipartisan CARES Act that provides $100 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get testing and treatment for COVID-19.

Payments arriving under the CARES Act Provider Relief Fund will arrive via direct deposit beginning April 10, 2020 - to eligible providers throughout the American healthcare system, are payments, not loans, to healthcare providers, and will not need to be repaid.

Who is eligible for initial $30 billion? All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution.

  • Payments to practices that are part of larger medical groups will be sent to the group's central billing office.
    • All relief payments are made to the billing organization according to its Taxpayer Identification Number (TIN).
  • As a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.
  • This quick dispersal of funds will provide relief to both providers in areas heavily impacted by the COVID-19 pandemic and those providers who are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services.

How are payment distributions determined?

  • Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.
  • A provider can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments they received by $484,000,000,000, and multiply that ratio by $30,000,000,000. Providers can obtain their 2019 Medicare FFS billings from their organization's revenue management system.

4/10/20: Statewide Process for LTC Facility to Facility Transfers- COVID-19: Nebraska Medicaid Provider Bulletin 20-07 Nebraska Department of Health and Human Services (DHHS) is modifying certain policies in regards to requirements for licensure of temporary settings, discharge and admission for facility to facility transfers. In the event that a facility has multiple residents who are positive for COVID-19 and a quarantine becomes necessary DHHS will be able to assist providers and residents to act quickly and efficiently to protect and provide necessary care for the elderly and disabled. Nebraska Medicaid has worked with Public Health to identify ways to modify the facility to facility transfer process during this COVID emergency. If the resident is transferred due to COVID-19 circumstances the sending facility must agree the resident will return after the emergency.

4/10/20: States Take Action to Sustain Adult Day Services through COVID-19: This article provides an update of what policy actions states are taking action to provide funding adult day services providers through the COVID-19.

4/10/20: FEMA Public Assistance Program for COVID-19 Expenses: The Federal Emergency Management Agency (FEMA) is offering financial assistance to state, territorial, tribal, and local government entities and certain private not-for-profit organizations, including 501(c)(3) healthcare and senior living organizations. In fact, FEMA has begun awarding funding to state emergency management agencies under the Public Assistance Program for eligible response activities related to the COVID-19 pandemic.

4/10/20: Decisions, Decisions: Implementing the New Emergency Paid Sick Leave and Paid FMLA Provisions: Are you looking for some help related to how the new emergency paid sick leave and paid FMLA provisions impact you?  Check our this guidance document from LeadingAge that will walk you though your questions and decision-making process.

4/10/20: CMS Temporarily Suspends Rules to Help Maximize Frontline Workforces to Confront COVID-19 Crisis: CMS has temporarily suspended a number of rules so that hospitals, clinics, and other healthcare facilities can boost their frontline medical staffs as they fight to save lives during the 2019 Novel Coronavirus (COVID-19) pandemic. These changes affect doctors, nurses, and other clinicians nationwide, and focus on reducing supervision and certification requirements so that practitioners can be hired quickly and perform work to the fullest extent of their licenses. The new waivers expand the workforce flexibilities that CMS announced on March 30. The changes that CMS announced are made to assist healthcare facilities across the nation can expand their staffs and organize them in the most efficient way possible to handle the incoming surge of COVID-19 patients.  Many waivers have been issued to date.  CMS has a document outlining the full list of waivers.

4/8/20: Do you want to know more about the Payroll Protection Act SBA funding options and the specific impact on your facility?  Here are some helpful Resources:

4/8/20: Extended Offer: COVID-19 Learning Tool: As you consider or implement training of Temporary Nurse Aide in your facilities in Nebraska, here is a resource that can help provide education related to COVID-19.

NextStep is offering an informal online course designed to improve the safety of caregivers of all kinds working with COVID-19 patients in all settings. The COVID-Ready Caregiver program uses expert-developed online learning to help develop safety skills during the pandemic. *Staff at LeadingAge members can access the course at no cost, and we just extended the offer so it's valid through April 17. Use code COVIDCERTNOW at check-out.

The program is NOT a formal certification and is intended to complement additional training. It can also be used by caregivers, housekeeping, and dietary teams, or any staff at independent living, HCBS, adult day, PACE, affordable housing, or other settings, as well as by family caregivers at home.

4/7/20: Important Reminders Related to Reporting and PPE: As we see COVID-19 positive residents and providers coming up across the state, here are a few REMINDERS:

  • Most Local Public Health Departments ask that you to contact them when you are sending a team member or resident for testing. Click HERE for a map of the Local Health Districts and Emergency Response and Epidemiology contact information.
  • Local Health Departments are also taking information on PPE needs.  Please be sure to fill out the request form with your LHD. Because PPE is limited and difficult to acquire, DHHS is recommending that you continue to place orders with your normal supplier as well.
  • Waivers are in place for CNA and MA that suspend some of the requirements for these workers. You can train temporary CNAs in-house, without curriculum approval and you can start NOW.  Remember, you can train a temporary CNA to perform limited, specific functions as well, like helping with feeding at dining time. If you have questions on these temporary changes, please see the 4/6/20 update or contact Jenifer.

4/7/20: Questions related to management of laundry, food service and medical waste? A few questions have come in regarding use of disposable versus not disposable items for food service.  CDC has guidance available for this and more.

4/6/20: Important Reminders for Team Members: As we see COVID-19 positive residents and providers coming up across the state, here are a few REMINDERS from your member colleagues:

  • Make sure that you have a policy in place that tells team members to inform you if they are being tested.  Testing for healthcare workers is being prioritized.  Make sure that they alert the lab that the individual is a healthcare worker and also whether they are symptomatic or asymptomatic-this will influence how the test is processed.
  • Make sure that you have a policy in place, at least during this time, that if your team members are employed in other healthcare settings that they inform you of other employment.  This information is particularly important should your location or the other location have a COVID-19 positive case, so that you can communicate with one another.

4/6/20: Temporary CNA and Medication Aide Options - With Guidance from Dan Taylor, DHHS Program Manager: CMS has relaxed some of their requirements related to CNA testing and the 120 period for testing. In conjunction with that, Governor Ricketts, through his Executive Order (EO 20-12) suspended some of the rules for Nurse Aide training.

Facilities can now train temporary Nurse Aides.  These do not have to be people already working in a different capacity in your facility.  These can be new employees. They must be trained and demonstrate competency of duties. This training can be done by a licensed healthcare provider working within the scope of his/her license. The individual being trained must demonstrate training in the core competencies. The training can be done in-house and the curriculum does not need to be approved.  Training documentation, including a sign-off on each competency demonstrated, should be maintained by the facility. Nurse Aides can also be trained to provide assistance with non-complex feeding.

Facilities can now train non-40 hour Medication Aides. Under the same state Executive Order mentioned above, for this period of time NF and AL do not have to have 40-hour MAs. The MA still has to be trained and be on the registry, but is not required to meet the 40 hour criteria. * More information to follow as it becomes available*

4/3/20: CMS COVID-19 Long-Term Care Facility Guidance *NEW RECOMMENDATIONS*

4/3/20: Nebraska DHHS General Statewide Telehealth - COVID-19 Frequently Asked Questions: As telehealth use is expanding, please see this FAQ from Nebraska DHHS with more information.

4/3/20: COVID-19: Telehealth Billing Correction, Nursing Home Recommendations, Billing for Multi-Function Ventilators, New ICD-10-CM Diagnosis Code (from MLN): April 3 Update

  • Billing for Professional Telehealth Distant Site Services During the Public Health Emergency - Revised- Correction to 3/31/20 issuance
  • Trump Administration Issues Key Recommendations to Nursing Homes, State and Local Governments
  • Billing for Multi-Function Ventilators (HCPCS Code E0467) under the COVID-19 Public Health Emergency and Otherwise
  • New ICD-10-CM diagnosis code, U07.1, for COVID-19

4/2/20: 1135 Waiver Response from CMS to Nebraska: On March 30, 2020 Nebraska DHHS MLTC submitted a request for waivers to certain federal provisions under the March 13, 2020 Presidential Proclamation.  Nebraska received the waiver approval today.  The waiver grants flexibility in a number of areas, including prior authorization, PASRR timeframes, appeal time frames and more.

4/2/20: CARES Act Expands Federal Small Business Loans, Can Support Aging Services: This article provides a summary of the small business loan provisions included in the CARES Act and potential next steps for aging services providers. Loans will be available effective April 3.

4/2/20: Quickly Reversal by IRS: No Need to File to Receive Checks: Despite stating on March 30 that seniors and others who do not need to file taxes would have to do so in order to receive the CARES Act checks, the IRS reversed itself on April 1. "Social Security recipients who are not typically required to file a tax return need to take no action, and will receive their payment directly to their bank account," Treasury Secretary Steve Mnuchin said late on April 1.  Checks received will NOT be counted toward income for other federal program eligibility.

4/2/20: CDC Recorded Webinar: Preparing Nursing Homes and Assisted Living Facilities for COVID-19: CDC Recorded Webinar: Preparing Nursing Homes and Assisted Living Facilities for COVID-19If you missed the CDC Webinar related to preparing Nursing Homes and Assisted Living Facilities, discussing key strategies for preparing long-term care facilities COVID-19, and would like to view the recording, click HERE.  This recording contains basic information as well as tools for tracking staff and other direction.