*Updates are listed by date with the most recent listed first.
Need to Know Updates
4/21/21: Need to Know-Information from the past week:
- DHHS Issues Health Alert Network (HAN) regarding Norovirus outbreaks: Since March 1, 2021, the Nebraska Department of Health and Human Services Office of Epidemiology has received reports of 14 suspected or confirmed norovirus outbreaks among long-term care facilities, skilled nursing facilities, childcare centers, and schools. The norovirus season typically peaks from December to March, and begins to decline in April. Norovirus activity has been unusually high for this time of year, so we urge all facilities to review the document below to focus on preventing and containing the spread of norovirus in Nebraska. Any facility with two or more ill persons within 72 hours should report the suspected outbreak to their local health department. See map and contacts here.
- On the member call today, Dr. Ashraf shared that those residents who have been vaccinated and who have subsequently tested positive for COVID have had little to no symptoms, which is good news. Those unvaccinated staff who have tested positive have had symptoms at a much higher rate.
- There were a number of questions on today's call related to vaccinated residents and communal dining. Here is the guidance that DHHS put out regarding communal dining and activities for vaccinated and unvaccinated residents. Dan Taylor with DHHS noted that there may be any number of reasons to utilize alternate practices, for example for a resident who is hard of hearing.
- REMINDER OF FRIDAY CALL WITH JEREMY BRUNSSEN, DEPUTY DIRECTOR WITH MLTC. Do you have questions about how the Medicaid nursing facility rate setting will work for next fiscal year?
LeadingAge Nebraska is happy to host Jeremy Brunssen, Deputy Director of Medicaid & Long-Term Care, as he joins LeadingAge Nebraska members to present on appropriations, bed day calculation projections, and the MLTC general plan related to Medicaid rates for Nursing Facilities that will go into effect July 1, 2021. Jeremy will also be available to answer your questions following his presentation. See webinar details under "Calls this week" below.
Just in from the CDC: CDC revealed on today's CMS Nursing Home Stakeholder call that CDC will be releasing updated guidance as early as Friday, April 23, on what people should do in nursing homes post-vaccination. The guidance will address visitation, group activities, and testing. Stay tuned as more information will be provided when it becomes available.
CMS National Nursing Home Stakeholder Call: CMS held a national stakeholder call this afternoon to review recent updates:
- Public health emergency extended: The public health emergency has been extended for another 90 days, effective today. With this extension, the current 1135 waivers have also been extended (with the exception of those outlined in CMS memo QSO-21-17-NH to terminate on May 10).
- Pending termination of select 1135 waivers: As we reported previously, CMS will be terminating select 1135 waivers effective May 10, 2021. The waivers that will be terminated relate to notice of transfer and discharge, notice of room or roommate change, timely submission of MDS, and timely completion of care plans. The 3-day stay waiver and all other waivers remain in effect until the end of the public health emergency. For more information on terminated waivers, read here. LeadingAge national has also updated the federal blanket waivers chart, which can be accessed here.
- FY 2022 SNF PPS rule: The proposed FY 2022 SNF PPS rule was released on April 8. Comments on the rule are due June 7. Read LeadingAge's initial overview of the rule here.
- Update on vaccination programs: The Long-Term Care Pharmacy Partnership Program has now completely wrapped up in nursing homes and assisted living. Providers should now be working with long-term care pharmacies through the Retail Pharmacy Program. Check here for more information on this program and a list of participating pharmacies.
4/21/21: Provider Relief Fund Issue Resolution Contact: For members who have encountered issues with obtaining Provider Relief Funds, the new administration would like members/providers to reach out to HRSA (the division of HHS handling PRF) directly. Last week we shared that there would be an email forthcoming to contact HRSA directly. The email is: ProviderReliefContact@hrsa.gov HRSA did not specify any limits to the inquiries that a provider could make using this email address but some issues may include: TIN Validation issues, missing funds, etc. If members are unable to resolve issues successfully, you can still reach out to Jenifer (firstname.lastname@example.org) to assist in facilitating contact with LeadingAge national subject matter expert, Nicole.
4/21/21: CDC Foundation Request for Proposals to Support Community-Based Organizations to Increase Vaccination Coverage: The CDC Foundation is putting out a request for proposals for $50-100K grants aimed at Supporting Community-based Organizations to Increase Vaccination Coverage Across Different Racial and Ethnic Adult Populations Currently Experiencing Disparities. The grants are aimed at community based organizations; there are LeadingAge members who would likely qualify. If interested, please read the eligibility criteria carefully - these grants are not aimed at covering the costs of providing clinical services (e.g. administering vaccines). There are also restrictions on who can own the entity applying (e.g. not a university or hospital, but it can be a foundation associated with a clinical care provider).
The turnaround time is very fast. The RFPs are due by May 3, 2021. Here are the RFP, slides from a CDC presentation on the opportunity, and an FAQ.
4/21/21: COVID-19 Community Corps: The HHS COVID-19 public education campaign is a national initiative to increase public confidence in and uptake of COVID-19 vaccines while reinforcing basic prevention measures such as mask wearing and social distancing. Specifically, the COVID-19 Community Corps works to engage with a broad range of groups and individuals, including trusted community organizations, local leaders, and others sharing the goal of increasing vaccine confidence and uptake. Join the COVID-19 Community Corps here, and view their resources, toolkits, and information on how to communicate with others about protecting themselves and their communities.
4/21/21: Vaccine Eligibility: CDC updated the following COVID-19 information pages to include that everyone 16 years of age and older is now eligible to get a COVID-19 vaccine: Vaccine FAQs, How Vaccines Get to You, Key Things to Know, and Vaccine Rollout Recommendations. CDC also updated the following information pages for specific communities to include the expanded eligibility of the COVID-19 vaccine: persons with disabilities, essential workers, healthcare personnel, older adults, and those high risk for severe illness. Get a COVID-19 vaccine as soon as you can. Moreover, CDC updated their general vaccination resources, including information on preparing for your vaccine.
4/21/21: Essential Workers Bill Introduced: LeadingAge national supports the introduction of the Citizenship for Essential Workers Act (S. 747/H.R. 1909), which allows undocumented persons already working in the U.S. as essential workers during the COVID-19 pandemic, and certain family members, to be given a pathway to citizenship. The proposal amends the Immigration and Nationality Act to provide for the adjustment of status of essential workers to permanent status. Eligible persons include essential workers in the non-profit health care sector or home and community-based occupations (i.e., home health and residential care, and activities of daily living) and family caregivers. An article with additional details on the legislation will be available from LeadingAge national soon.
4/21/21: Quarterly Affordable Housing Survey: Calling all affordable housing providers! Reminder to take our quick pulse-check on vaccines, COVID testing, HUD payments, and more. Please take a moment to complete the survey by Friday, April 23.
4/21/21: Deadline Approaching: HUD Announces Third Round of CSP Funds: HUD has opened the third round of application submissions for affordable housing providers to apply for funds to offset COVID-19 costs. Properties can apply for reimbursements for certain COVID-19 expenses that occurred between December 1, 2020, through March 31, 2021, and the deadline to submit CSP requests to HUD is April 26. This new round of supplemental payments can cover PPE associated with conducting vaccination and testing events and temporary clinics at the property; and vehicle reimbursement for transportation associated with vaccination. More information here.
4/21/21: A Deeper Look at LeadingAge's Affordable Housing Policy Priorities: Building on LeadingAge's 2021 policy priorities and on the President's goals of overcoming COVID-19, LeadingAge recommends various focus areas to advance HUD's affordable senior housing programs. The policy recommendations include housing and services, internet connectivity, and equitable COVID-19 recovery.
4/14/21: Information tidbits from the past week (vaccine and non-vaccine related):
- During today's member call with DHHS, Becky Wisell shared that a emergency contract would be completed this week for a new IDR and IIDR vendor. This contract will address the backlog of pending appeals. There will be an RFP issued to seek multiple vendors for IDR and IIDR services in the future. Becky indicated that the contract should be signed this week. If you have a pending request, you may be contacted by the new contractor in the near future.
- Becky also shared that Doug Carlson (who handles the State PPE reserve) has gloves available through the State warehouse for providers who need them. If you are in need of gloves, you no longer have to demonstrate that you have exhausted all other avenues to request them through the State supply. Doug shared that he would like to get the supplies distributed to those who need them. Below is the link to the jot form to request PPE through the State. If you are in Lancaster County, you should make your PPE requests directly to the Lancaster County Health Department.
- Dr. Ashraf shared that there were 35 COVID-19 staff cases and 19 COVID-19 resident cases in Nebraska last week. Those numbers are an increase from the previous week. Many of the residents infected were fully vaccinated. Most of the staff who were positive were not vaccinated.
- Dr. Ashraf also shared that DHHS is seeing residents (2-3 so far) who have received a third dose of vaccine. The State immunization registry (NESIIS) does not contain timely information. When it is necessary to determine if a resident needs vaccination, you can look in NESIIS. IF you see 2 vaccines included, you can depend on that information. If you only see 1 vaccine, it is possible that the second has been administered but not yet entered. The same applies if you do not see any vaccines in the system. Dan reminded providers to use due diligence to determine resident vaccination status. Look for a vaccine card, talk to the resident and the resident's family, check the medical records.
4/14/21: CDC ACIP Meeting on Johnson & Johnson: CDC convened an emergency meeting of the Advisory Committee on Immunization Practices (ACIP) today to further review the six reported cases in the US of a rare and serious type of blood clot that occurred after administration of the J&J vaccine. According to media reports, the ACIP decided at its meeting that it wanted more data before deciding whether to resume use of Johnson & Johnson's single-shot coronavirus vaccine, calling for more information on the risks, cause, and frequency of the rare and severe type of blood clot. Additional resources are below:
- Joint CDC and FDA Statement on Johnson & Johnson COVID-19 Vaccine
- Joint Media Call: FDA & CDC to Discuss Janssen COVID-19 Vaccine
- Latest News from CDCs Health Alert Network
- Frequently Asked Questions about VAERS Reporting for COVID-19 Vaccines
- Nebraska HAN related to Johnson & Johnson COVID-19 Vaccine
4/14/21: Provider Relief Fund Update: LeadingAge national has heard from HRSA (who administers the PRF under HHS) that the application portal for distributing the next round of PRF dollars will be open "soon" and will look similar to the Phase 3 process, by which we expect HHS to request financial data from providers outlining their lost revenues and possibly increased expenses from COVID-19 from the last half of 2021 and it will be compared to PRF payments received to date. HRSA has also indicated that they want providers to contact them directly regarding questions or problems they have encountered with the PRF (e.g. no TIN validation, awaiting funds, etc.) instead of going through association staff. If you have issues that you cannot get resolved, please let Jenifer know and she will share with LeadingAge national staff who can help get answers. HRSA contact information will be made available soon.
4/14/21: CDC Weighs In on "Reopening" Risk in Independent Living: With vaccine distribution well underway across the country, affordable senior housing providers are navigating decisions around "reopening" or loosening restrictions at communities. The CDC has described the risk of COVID-19 spread in retirement communities and independent living based on various activities, and the CDC is seeking feedback on further information needed. More info here.
4/14/21: FY 2022 SNF PPS Proposed Rule: The FY 2022 SNF PPS proposed rule is available on the public inspection site of the federal register and will be published to the federal register tomorrow. Read our overview of main provisions here. CMS proposes a 1.3% rate increase for FY 2022. Other key points include new consolidated billing exclusions, considerations for a PDPM parity adjustment, 2 new QRP measures including a measure on staff COVID-19 vaccination rates, suppression of the SNF VBP measure and future expansion to include additional measures. Comments on the rule are due June 7. LeadingAge will be soliciting member feedback over the coming weeks.
4/14/21: HUD Announces Third Round of CSP Funds: HUD has opened the third round of application submissions for affordable housing providers to apply for funds to offset COVID-19 costs. Properties can apply for reimbursements for certain COVID-19 expenses that occurred between December 1, 2020, through March 31, 2021, and the deadline to submit CSP requests to HUD is April 26. This new round of supplemental payments can cover PPE associated with conducting vaccination and testing events and temporary clinics at the property; and vehicle reimbursement for transportation associated with vaccination. More information here.
4/14/21: Temporary Halt in Residential Evictions: CDC updated their information on the temporary halt in residential evictions to prevent the further spread of COVID-19. Director Dr. Rochelle Walensky signed a declaration determining that the evictions of tenants could be detrimental to public health control measures to slow the spread of SARS-Cov-2, the virus that causes COVID-19.
4/12/21: CMS Terminates Select Federal Blanket Waivers: CMS released this memo last Thursday night announcing the termination of 4 federal blanket waivers related to resident transfer and discharge, room and roommate changes, completion of care plans, and submission of MDS data. These waivers will be terminated effective May 10, 2021. The 3-day stay waiver IS NOT being terminated and remains in effect at this time. Additionally, the memo provided clarification of the nurse aide training waiver, which also remains in effect at this time. Read more here. LeadingAge national has updated our blanket waivers chart for reference, which can be found here.
Recall that unless otherwise noted, federal blanket waivers remain in effect until the end of the public health emergency. The public health emergency is currently set to expire April 20, 2021, but it is anticipated that it will be extended for another 90 days without interruption.
4/12/21: Proposed Hospice Wage Index: Here is an article from LeadingAge national with more details on the Proposed Hospice FY 2022 Wage Index and Payment Update, Hospice Conditions of Participation Updates and Home Health and Hospice Quality Reporting Program Requirements.
4/12/21: Optimizing N95 Respirator Supplies: Both the FDA and CDC updated their strategies for optimizing N95 respirator supplies. As of April 9, CDC acknowledged that the supply and availability of NIOSH-approved respirators have increased significantly over the last several months. In regard to conventional capacity strategies, CDC added language on extended use of N95 respirators as source control, as well as language on use of respirators with exhalation valves. For contingency capacity strategies, CDC added a strategy to prioritize respirators for HCP who are using them as PPE over those HCP who are only using them for source control. They also clarified that for extended use of N95 respirators as PPE, N95 respirators should be discarded immediately after being removed. For crisis capacity strategies, CDC removed the strategy of using non-NIOSH approved respirators developed by manufacturers who are not NIOSH-approval holders, removed decontamination of respirators as a strategy with limited re-use, and removed the table "Suggested well-fitting facemask or respirator use, based upon distance from a patient with suspected or confirmed SARS-CoV-2 infection and use of source control." CDC highlighted that the number of reuses should be limited to no more than five uses (five donnings) per device by the same HCP to ensure an adequate respirator performance, and emphasized that facemasks for caring for a patient with suspected or confirmed SARS-CoV-2 infection should only be used for certain scenarios as a last resort if respirators are severely limited.
4/12/21: White House Asks Congress for 15% Increase to HUD Funding: On April 9, the White House delivered its topline funding requests for fiscal year 2022 (FY22) to Senate and House appropriators. The topline request seeks a 15.1%, or $9 billion, increase to HUD funding compared to fiscal year 2021 funding. The request includes $180 million to support 2,000 units of new permanently affordable housing for older adults and persons with disabilities through the Section 202 and Section 811 program, respectively, but does not say how much the requested level for each program. The request seeks full contract renewal funding plus $800 million across the HUD portfolio for modernization and rehabilitation. The request also seeks funding for 200,000 new Housing Choice Vouchers, a $500 million increase to the HOME Investment Partnerships Program, and a $500 million increase for Homeless Assistance Grants to support more than 100,000 additional households, helping prevent and reduce homelessness. An article is here.
4/12/21: President's Budget Request: The President's FY 22 budget called for a 23.1% increase from last year in order to help address the public health response to the pandemic. The request includes a 23% increase for HHS. He requested a $1.6 billion increase in the CDC budget, the largest annual jump in two decades, aimed at heading off the next pandemic. The discretionary request builds on significant investments provided in the American Rescue Plan Act of 2021 by providing additional resources for the Administration for Community Living to help older adults and people with disabilities maximize their independence and well-being. The discretionary request provides relief to caregivers and families, including $551 million for home and community-based services, doubles funding for the Lifespan Respite Care program, increases resources for meal programs for older Americans, and expands services for individuals with disabilities. (Medicare and Medicaid are entitlement programs, and not included in the discretionary budget.)
4/12/21: FCC Posts Emergency Broadband Benefit Resources: The Federal Communications Commission (FCC) posted additional resources for the new Emergency Broadband Benefit (EBB), which provides a monthly discount on internet services for income qualifying households across the country. In addition to recently uploaded FAQs, the FCC has also posted a tool that allows partners and consumers to view by state or territory the providers that will be participating in the Emergency Broadband Benefit program; the list currently includes many of the country's biggest ISPs, as well as local and regional providers. Separately, the FCC announced an upcoming webinar on the new benefit; more info here.
4/12/21: HUD Posts Updated NSPIRE Standards, Looks for Feedback: As HUD moves forward with its NSPIRE overhaul of physical inspections, the agency posted an updated set of draft building standards (V2.1) that will be evaluated during inspections under the new NSPIRE model. LeadingAge national has identified several key standards updates in Version 2.1, including related to bathtubs and shower functionality, carbon monoxide detectors, exhaust ventilation, electrical components, and fire extinguishers. HUD is still welcoming informal comments on the draft standards and LeadingAge national is compiling feedback on HUD's specific questions. More info here.
4/8/21: A Note from Jenifer: Hello LeadingAge Nebraska Members! Over the past several weeks there have been many questions about how to obtain vaccinations for new residents and staff members. Many of you contacted your Local Health Departments to determine what their plan was for these vaccinations. Information varied depending on geographic location and who you talked with. DHHS, ICAP, and the associations undertook a review of this process, with the hope of pulling together a comprehensive reference document. This morning, DHHS provided the Nebraska Local Health Department LTC Vaccination Plan. This guidance document includes specific information on who to contact (including contact info), and the plan for how resident and staff vaccinations will be handled.
A big thank you to the ICAP team for making their resources available to collect, review, and analyze the information and for drafting this document. If you'd like to hear more, this plan will be covered as a part of the ICAP call at noon CT today. You can join the Nebraska ICAP team for the Weekly Long-Term Care call via Zoom: https://unmc.zoom.us/j/94892899060?pwd=WXZhQWxuOUpuNU5HZjZUMWJINWR0UT09 Passcode: 042010
4/7/21: Information tidbits from the past week (vaccine and non-vaccine related):
- During today's member call with NE DHHS, Becky Wisell shared that there was an update yesterday to the State Guidance on Communal Dining/Activities for NF and AL that was released last week. The wording "will" was changed to "should" in 2(b)(i) and 2(b)(ii).
- Dan Taylor with DHHS survey acknowledged that the best practices provided in the guidance regarding group activities may not work in all instances and that consideration should be given to the circumstances of the resident, the facility space, and a number of other considerations while focusing on infection control.
- Dr. Ashraf shared on today's call that there were 11 residents and 36 staff diagnosed with COVID-19 last week. The 11 residents were fully vaccinated and demonstrated minor or no symptoms. The samples for these residents have been submitted for variant sequencing. *REMINDER- be on guard for vaccine breakthrough cases. There have been a number of COVID variant cases around the state. Click HERE to access the Reinfection and Vaccine Failure reporting form.
- Both DHHS and ICAP representatives gave reminders on the importance of testing as required and in cases where there are positives identified. CMS QSO 20-38-NH on testing continues apply.
- Team members with allergies failing screening? It is allergy season and many team members have symptoms that could be allergies...or COVID-19. Dr. Ashraf provided the following guidance:
- If a team member fails screening, complete a POC test.
- If the POC test comes back positive, the team member needs to be off of work. If the POC test comes back negative complete a PCR test.
- If the PCR test is positive, the team member needs to be off of work.
- If the PCR test is negative, determine risk, consider a health evaluation. If PCR was negative at the start of symptoms, the team member can indicate "change" or "no change" to symptoms on the screening document. If there is no change in symptoms, you may want to re-evaluate at some point. This prevents a team member from having to do a PCR test following each screen.
4/7/21: Peer-to-Peer Resilience Curriculum: Here is a link to a resilience curriculum developed by the UNL Center for Public Policy (based on their peer-to-peer resilience work): https://go.unl.edu/bounceback.
The curriculum is an adaptation of the Nebraska peer-to-peer resilience curriculum that is based on three evidence informed practices: Psychological First Aid (PFA); Skills for Psychological Recovery (SPR); and the FEMA/SAMHSA sponsored Crisis Counseling Program Training Curriculum.
This training beings with a short survey that includes a "brief resilience scale" allowing you to assess your personal resilience right now. After the survey, participants will have the opportunity to view three videos. Under each video there are handouts (PDF) you can download.
- Part 1: Resilience (27 minutes)
- Part 2: Coping Tools (49 minutes)
- Part 3: Helping Others (15 minutes)
4/7/21: Provider Relief Fund Update: HHS Updates Provider Relief Fund FAQs on March 31 and the newly modified and added questions that address issues related to complying with the terms and conditions, ownership structure and financial relationships, and use of funds questions. LeadingAge national has provided an article on the recent updates to the PRF FAQs. Nicole with LeadingAge national will be discussing these items along with what we know currently on PRF and answering questions on the Member Coronavirus Call on Thursday.
4/7/21: CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum: CMS announced an Open Door Forum to discuss the forthcoming SNF PPS rule.
Date: Thursday, April 15, 2021
Start Time: 2:00 PM - 3:00 PM Eastern Time (ET);
Please dial-in at least 15 minutes before call start time.
This call will be Conference Call Only.
To participate by phone: Dial: 1-888-455-1397 & Conference Passcode: 8604468
4/7/21: Guidance for Older Adults: CDC updated their information for older adults. Risk for severe illness with COVID-19 increases with age, with older adults at highest risk. Certain medical conditions can also increase risk for severe illness. People at increased risk, and those who live or visit with them, need to take precautions to protect themselves from getting COVID-19.
4/7/21: CDC Travel Guidance Update: The end of last week CDC shared new travel guidance. Here is information on how to handle both vaccinated and unvaccinated individuals.
- For fully vaccinated individuals- Those who are at least 2 weeks past the final dose in their vaccine series are considered fully vaccinated and can safely travel within the US while continuing to practice mitigation measures including masking, social distancing, avoiding crowds, and practicing hand hygiene. Fully vaccinated healthcare personnel do not need to be restricted from work. Fully vaccinated residents do not need to quarantine upon return to the nursing home.
- For unvaccinated individuals- Those who received the final dose in their vaccine series less than 2 weeks ago, who have received only one shot in a 2-shot series, or have received no vaccination at all must all follow the guidance for unvaccinated individuals. This means getting a viral test 1-3 days prior to traveling, another viral test 3-5 days after returning from travel, and self-quarantining for 7 days after returning from travel.
CDC recommends that unvaccinated individuals avoid being around people who are at increased risk for serious illness for 14 days after travel. CDC recommends that unvaccinated residents quarantine for 14 days following readmission (returning to the nursing home when being out for more than 24 hours).
Everyone must follow state guidelines. The CDC has created this search tool, also linked in the travel guidance, to help identify specific state guidance.