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

12/31/20: UHC Contract Addendums and Emails Regarding Bonus Opportunities: I was able to speak to Jeff Stafford, CEO with Nebraska UHC, this afternoon regarding an email that went out to providers from UHC that started rolling out yesterday.  HERE is a link to some background that he provided me related to the program.  The program includes:

  • Incentives for flu and pneumonia vaccinations for UHC affiliated Medicaid eligibles
  • Bonus for vaccination reviews UHC affiliated DSNP residents for December and January.

If you received an email from UHC about the Contract Addendum and Bonus possibilities it is legitimate and for your December bonus opportunities IT DOES REQUIRE THAT THE DOCUMENTS BE EXECUTED BY THE END OF THE DAY TODAY, but they do not require the items back until the first week of January. UHC would have emailed you, directly, the census form that they have for your facility outlining the Medicaid eligible residents in your facility who may qualify for the vaccine incentive OR the DSNP bonus.  However, Mr. Stafford provided the following UHC Vaccination Template if you would like to develop your own list of UHC Medicaid eligible members or DSNP residents. These incentives are available to ALL Nebraska NF providers who work with UHC clients.

LeadingAge Nebraska will be engaging in conversation with UHC Medicaid related to other incentives that may be available for NFs in 2021.  If you have ideas, please send them to me.  

UHC indicated that they understand and acknowledge that the bonus and other information is last minute, but they wanted to make the opportunity available and commit to work toward better planning in the future.

12/31/20: Vaccination Guidance for Workforce from NDHHS

Information provided by Nebraska DHHS (Becky, Dan, and Connie) indicates that they will treat the vaccination of LTC Healthcare Personnel as having the potential to create a critical staff shortage issue.  In order to prevent a critical Healthcare Personnel shortage situation, NDHHS will adopt the use of the CDC guidance for Post Vaccination Considerations for Healthcare Personnel.  Attached are two documents that have been created based off of the CDC guidance.  One is for Healthcare Personnel and one is for residents.  This does not change screening requirements for staff, visitors or residents and the need to document why a staff person is allowed to work with COVID like symptoms. This also doesn't change any of the CMS testing requirements for facilities.  The Survey Teams are being made aware of this guidance as well.  

12/29/20: LTC Vaccination Information: Over the past week many of you involved in the LTC Pharmacy Partnership with Walgreens, CVS, or Community Pharmacy have received information and even had clinics already. Some of you who are assigned to a partner have not yet been given clinic date information. Some of you did not get signed up for the LTC Pharmacy Partnership and are working with your Local Health Department to set up clinics.  Some of you thought that you would be working with your Local Health Department and have been contacted by your LHD indicating that they plan to partner with a local pharmacy partner. With all of those options, which seem to change by the day, it is understanding why there is some confusion. 

To help you as you work through your questions we will have the Pharmacy Partners and DHHS on our call tomorrow at 10:00 CT. LeadingAge national has also hosted both CVS and Walgreens on calls in the past week. Below you will find contact information for CVS, Walgreens, and Community Pharmacy, including links to the CVS and Walgreens information.

12/29/20: The LeadingAge Nebraska update from 12/28 (last night) includes a number of pointers and resources available from ICAP, DHHS, CDC, Pfizer, FDA, and others.

  • CVS: CVS Provided the following information to LeadingAge Nebraska yesterday (this was included in the update for 12/28): CVS Vaccine Clinic Scheduling Phone Number & Point of Contact Assignments
    • CVS/Omnicare has provided a 1-833 number and has assigned each facility a point of contact (POC) for questions.
    • Facilities can call1-833-968-1756 to schedule the LTC clinic date or verbally confirm their clinic date once scheduled.  This number is for scheduling purposes only. Any additional questions should be forwarded to the facility's designated Point of Contact so not to impact timeliness or responsiveness of the scheduling call center.
    • Point of Contacts can help the LTCF learn about the process, how to fill out consent forms, align the facility on next steps, answer questions involving insurance, update contact information, keep the facility updated, and share information in as much real-time as possible (like the call center to confirm dates). If you haven't yet received a point of contact, please reach out to CovidVaccineClinicsLTCF@CVSHealth.com with questions.
    • Additional Information: It has become apparent from some of our conversations that the LTCFs are replying to the "noreply" emails they get scheduling their clinics.  Those emails don't go anywhere. Please direct emails to the CVS Covid email box with questions:  CovidVaccineClinicsLTCF@CVSHealth.com
    • Here is some good information on the process and specifics about where facilities will be getting calls from and a reminder on where to find additional information that will be good for the facilities to have handy: 
    • COVID 19 Vaccination Clinic Scheduling Process:
      • CVS will send at least two emails regarding your facilities clinic dates/times. These clinic emails will come from no-reply@CVSHealth.com Please check spam/junk folders.
      • Once you have received your clinic dates/times, a CVS Health rep will call from 1-800-SHOP-CVS (1-800-746-7287)
      • If you are waiting for CVS Covid Center to call to confirm your date please call 1-833-968-1756
      • After the clinics are verbally confirmed by a CVS Health rep, the primary contact will receive a confirmation email from CVS
  •    Multi-Patient Registration Template:
    • Multi-Patient Registration Template
    • Multi-Patient Registration Guide
    •  The Multi-Patient Clinic Registration template file will be uploaded  to the Vaccine Clinic Scheduler
    • The Vaccine Clinic Scheduler link will be available once you have received the confirmation email from CVS with your confirmed clinic dates/time
    • Please gather residents/staff (front/back copy of insurance cards) in order to complete the Multi-Patient Registration Excel template, please save this information in a folder on your computer as you will need to access it in the future.
  • The Multi-Patient Registration will need to be uploaded before each clinic date. Be sure to update "column B" to reflect the correct dosage the resident or staff is receiving (i.e. First vaccination everyone should have a "1" in column B. The resident/staff receiving their booster shot should have a "2" in column B)
  • Contact Information Update: https://info.omnicare.com/Update-Contact-Info.html
  • Please remember to visit https://www.omnicare.com/covid-19-vaccine-resource/ as we have multiple guides, forms and information regarding the vaccination process, timeline, consent forms, CDC vaccine info and much more.
  • Walgreens: Over 900 members attended the LeadingAge National webinar today with Walgreens to discuss the COVID-19 vaccine distribution clinics. The Walgreens Head of U.S. Government Affairs, Ed Kaleta, gave an overview of the program and answered questions from members.  Here is an article summarizing the presentation and the Q and A. 
    • Members can go here for complete details on the Walgreens COVID-19 Vaccine Program. There is also a recording of the presentation and that can be viewed here.
  • Community Pharmacy: To find information related to the processes, forms, and contact information for Community Pharmacy, look HERE.

12/28/20: Need to Know Updates: Information tidbits from the past week (vaccine and non-vaccine related):

  • LTC residents who have received a recent vaccination (of any type) should not receive the COVID-19 vaccine for 14 days.  There is a 14 day window before receiving the COVID-19 vaccine and following receiving of the COVID-19 vaccination during which NO OTHER VACCINATIONS should be given.  If you have a recently admitted resident, you will want to make sure that they have not received any other vaccine in the 14 days prior. 
  • Per Dr. Ashraf:
    • Residents in the red zone should not receive vaccinations as a part of an on-site vaccine clinic.  
    • Residents and yellow, gray, and green may receive the vaccine.  
    • Green can be vaccinated and observed in a common area with masks and appropriate distancing.
    • Yellow and gray should receive vaccination in rooms if possible and can be observed in doorways with the door open for the 15 minute observation period.  The observation is 30 minutes for anyone who has had a history of anaphylaxis.  Yellow and gray MAY BE observed in small cohorts in a common area with masks, socially distanced, and with appropriate disinfection occurring IF NECESSARY due to staffing issues.  This is not the preferred approach.
    • Unlicensed staff or ancillary licensed staff may do post-vaccine observation.  A licensed member of the staff should be immediately available if needed.  Unlicensed staff should be trained on what to look for with residents and that "training" should be documented in their file (per Connie Vogt).
    • If a resident has been COVID positive, they should wait 10-21 days (depending on when their isolation is discontinued) to receive the vaccine. 
    • If a resident has received Bamlanivimab, he or she should wait 90 days to receive the COVID vaccine. 
  • Pharmacy Partners would like to remind you that they MUST have your completed Consent Forms prior to issuing vaccinations.  Again, both email and verbal consent are acceptable, but should be noted/included in the resident's record.  Provider staff may be asked to sign the pharmacy Consent and include information on how Consent was obtained. 
  • Per Sara Morgan with the Immunization Program, Local Health Departments are working with unmatched LTC providers to determine whether the LHD or an approved pharmacy will be overseeing the needs for clinics for those LTC locations.  Your Local Health Department (LHD) may have reached out to you to discuss options to work with state approved pharmacies.  
    • 131 Nebraska LTC facilities have vaccine clinics scheduled beginning this week, through which it is anticipated that 17,000 people will be vaccinated.  As of today, over 21,000 doses of vaccine have been administered across the state (outside of the LTC program). 
  • Per Dr. Ashraf:
    • If your staff receives vaccinations and has a fever they should be off of work.  
    • If the staff has symptoms that are not related to common side effects of the vaccine, the staff should be off of work.  In both of these circumstances you should consider testing. CDC updated information on the symptoms associated with COVID-19 and what to watch out for, note that respiratory symptoms (shortness of breath and coughing) are note included as vaccine side effects, nor is sore throat. 
    • If you have a staff member who has received the vaccine and continues to have vaccine related side effects for more than 48 hours, re-evaluate to determine if testing is warranted.
  • Last Friday the following HAN (Health Alert Network) Advisory was sent out to providers across the state in order to make all healthcare providers aware of the availability of Bamlanivimab treatment.

12/28/20: CDC LTCF Toolkit is LIVE: The LTCF Toolkit is meant a resource for explaining COVID-19 vaccination to both residents and staff in LTCFs. It includes resources for talking with staff, residents, and families, FAQs on the vaccines, and tips on how to prepare staff and vaccine safety monitoring and reporting.  If you are looking for easy to access information for staff, residents, and families, this is a great resource.  There are also printable documents for posting as well as vaccine stickers. 

12/28/20: LeadingAge Member Vaccine Clinic Experiences: Four LeadingAge members who held vaccine clinics (three through the Pharmacy Partnership, one through the county because of a state decision to go that route) last week joined the LeadingAge Coronavirus Update Call to share their experiences and tips. As would be expected, there were early bumps and challenges, but all four told very positive, reassuring stories.  They also offered several tips for providers getting ready to host clinics. One offered the thought that:  this is your clinic. Both LeadingAge Nebraska and ICAP have been emphasizing this as well. Remember to have your plan in place for the clinic and share that with the Pharmacy Partner (or others) as you drive the way the clinic will be set up and completed. As one LeadingAge panelist pointed out, "we are making history." Here is an article summarizing their comments and tips, any of which will sound familiar to our Nebraska providers.

12/28/20: LeadingAge (national) Call with CDC: LeadingAge participated in the bi-weekly partnership call with CDC, covering a number of topics today.  Here is some high level information about the information covered: 

  • LTCF Pharmacy Partnership: All but 2 states began vaccine clinics this week (Wyoming, Puerto Rico) with those 2 states beginning next week. Nursing homes within these states are scheduled by the pharmacies considering "best match" factors such as geographic clustering and size in order to maximize efficiency and minimize waste. CDC again noted that in the first week of vaccine clinics, the amount of vaccines requested exceeded the amount of vaccines actually accepted. CDC urges providers to get as accurate a count as possible, even notifying the pharmacy the day before of adjustments to numbers in order to avoid thawing vaccines that are not needed.  
  • NHSN COVID-19 vaccination module: We have heard from a few members already about a new COVID-19 vaccine module that went live on NHSN last week. This module allows for weekly reporting of COVID-19 vaccination in residents and staff. This is separate from the required vaccine reporting that the pharmacy will be doing, and any adverse event reporting that providers will be required to do. This reporting is optional and reports aggregate data. For this reason, we believe that reporting requires only Level 1 access. Currently, reporting is done through a manual data upload, but a CSV upload feature will be available in the future. There will be a webinar tomorrow, Tuesday, December 29, one set for 11:30 CT and another at 1:00 CT and the sign up link is here:  https://cdc.zoomgov.com/webinar/register/WN_898hxojMTDaZoYS_-BoS7Q

12/28/20: Point-of-Care Testing Reporting: HHS appears to have walked back the requirement that nursing homes must report point-of-care testing through NHSN to satisfy lab data reporting requirements. The June 4 Lab Data Reporting Guidelines have been once again updated without a new date and that troublesome bullet #4 under "Methods for Submission" is conspicuously missing this time around. CDC was able to confirm that nursing homes are still required to report point-of-care testing completed at the nursing home (per HHS requirements) and NHSN is now simply one option for the method of reporting. To break it down: if you're reporting through NHSN and this works for you, you can continue to report point-of-care testing through NHSN. CDC will still share this data with your state. If you prefer to revert to once again reporting point-of-care testing through your state platform, you have that option. Just be sure that you continue to complete the required reporting somewhere. For a review of the rule and your options for reporting, review here (Methods for Submission is at the top of page 2).

12/28/20: Updated CDC Guidance: COVID-19 Vaccination Considerations for Persons with Underlying Medical Conditions; at home testing; and funeral guidance. Adults of any age with certain underlying medical conditions are at increased risk for severe illness from the virus that causes COVID-19. mRNA COVID-19 vaccines may be administered to people with underlying medical conditions provided they have not had a severe allergic reaction to any of the ingredients in the vaccine. This information aims to help people in the groups listed below make an informed decision about receiving the mRNA COVID-19 vaccine.

The updated guidance on at home testing, issued today, is here.  The updated  funeral guidance is here and includes extensive resources and practical advice.

12/28/20: Translations of Moderna COVID-19 Vaccine Fact Sheet: The FDA has posted translations of the Moderna COVID-19 Vaccine fact sheet for recipients and caregivers, and the fact sheet for healthcare providers in languages including: Arabic, Chinese, French, Spanish, Tagalog, and Vietnamese. Additional language translations of the fact sheet for recipients and caregivers will be posted to this page as they are received.

12/28/20: Washington Post State by State Tracking of Vaccines: Here is a great article the Washington Post published and will update.  It includes a state by state summary of doses shipped, priority populations, and confirmed cases/deaths. 

CDC Information on Pfizer Vaccine: CDC released an information quick-sheet on the Pfizer COVID-19 vaccine yesterday, available here. You can find info about the vaccine itself, the side effects associated with the vaccine, and demographic information from the clinical trials. This guide also provides a link to how COVID-19 vaccines work.

12/28/20: LTC Pharmacy Partner Information:

CVS Provided the following information to LeadingAge Nebraska today: CVS Vaccine Clinic Scheduling Phone Number & Point of Contact Assignments:

CVS/Omnicare has provided a 1-833 number and has assigned each facility a point of contact (POC) for questions.

Facilities can call1-833-968-1756 to schedule the LTC clinic date or verbally confirm their clinic date once scheduled.  This number is for scheduling purposes only. Any additional questions should be forwarded to the facility's designated Point of Contact so not to impact timeliness or responsiveness of the scheduling call center.

Point of Contacts can help the LTCF learn about the process, how to fill out consent forms, align the facility on next steps, answer questions involving insurance, update contact information, keep the facility updated, and share information in as much real-time as possible (like the call center to confirm dates). If you haven't yet received a point of contact, please reach out to CovidVaccineClinicsLTCF@CVSHealth.com with questions.

12/28/20: Additional Information: It has become apparent from some of our conversations that the LTCFs are replying to the "noreply" emails they get scheduling their clinics.  Those emails don't go anywhere. Please direct emails to the CVS Covid email box with questions:  CovidVaccineClinicsLTCF@CVSHealth.com

Here is some good information on the process and specifics about where facilities will be getting calls from and a reminder on where to find additional information that will be good for the facilities to have handy: 

  •    COVID 19 Vaccination Clinic Scheduling Process:
    • CVS will send at least two emails regarding your facilities clinic dates/times. These clinic emails will come from no-reply@CVSHealth.com Please check spam/junk folders.
    • Once you have received your clinic dates/times, a CVS Health rep will call from 1-800-SHOP-CVS (1-800-746-7287)
    • If you are waiting for CVS Covid Center to call to confirm your date please call 1-833-968-1756
    • After the clinics are verbally confirmed by a CVS Health rep, the primary contact will receive a confirmation email from CVS
  •    Multi-Patient Registration Template:
    • Multi-Patient Registration Template
    • Multi-Patient Registration Guide
    •  The Multi-Patient Clinic Registration template file will be uploaded  to the Vaccine Clinic Scheduler
    • The Vaccine Clinic Scheduler link will be available once you have received the confirmation email from CVS with your confirmed clinic dates/time
    • Please gather residents/staff (front/back copy of insurance cards) in order to complete the Multi-Patient Registration Excel template, please save this information in a folder on your computer as you will need to access it in the future.
    • The Multi-Patient Registration will need to be uploaded before each clinic date. Be sure to update "column B" to reflect the correct dosage the resident or staff is receiving (i.e. First vaccination everyone should have a "1" in column B. The resident/staff receiving their booster shot should have a "2" in column B)

 12/28/20: Pfizer Vaccine Resources: Additional information and resources have been posted specific to the Pfizer vaccine including the EUA Fact Sheets translated into different languages.  Please see below for additional information: 

12/28/20: Monoclonal Antibody Pilot Project: Over 313 (51% of the positive residents between 12/1-12/23) Nebraska LTC residents have received monoclonal antibody treatment (Bamlanivimab) as of today.  Remember you can access ordering and administering information HERE

12/23/20: Information tidbits from the past week (vaccine and non-vaccine related):

  • Per Connie Vogt with DHHS, if you have a resident receive Bamlanivimab (monoclonal antibody) surveyors will ask you for documentation that the medication was administered according to the orders/standing orders.  If administered by another entity in your building or outside of your building keep documentation of when it was administered and who did the administration. 
  • Connie noted that the number of weekly FIC surveys has been reducing from around 50 per week to around 15 per week.
  • For the vaccine administration, it is recommended by DHHS that you have a temperature recorded prior to vaccination.
  • Per Sara Morgan with the Immunization Program, if you were not initially matched with a LTC pharmacy partner, your Local Health Department (LHD) may be reaching out to you to discuss options to work with state approved pharmacies.  Things are ever-changing, but this is the latest, more to come.
  • Per Dr. Ashraf:
    • If your staff receives vaccinations and has a fever they should be off of work.  
    • If the staff has symptoms that are not related to common side effects of the vaccine, the staff should be off of work.  In both of these circumstances you should consider testing. CDC updated information on the symptoms associated with COVID-19 and what to watch out for.
    • If you have a staff member who has received the vaccine and continues to have vaccine related side effects for more than 48 hours, re-evaluate to determine if testing is warranted.
  • Per the Governor and Dr. Anthone, assuming that hospitalization numbers do not increase, the state will move from yellow to blue for Directed Health Measures.  Here is the DHM guidance link. This is concerning given that LTC residents and many healthcare providers have not yet begun the vaccination process.
  • If you are looking for a vaccine fact sheet for residents or family members, try the one prepared by AMDA.  HERE is the link to AMDA's toolkit.  The resources, including the fact sheet, is free but you do have to sign in to receive access.
  • If you have a SNF and ALF co-located and there are sufficient doses of vaccine allocated to your facility, the LTC partner (or local partner) may provide vaccinations to residents of both during the same visit, per NDHHS.
  • New this week on the LeadingAge Nebraska website- Essential Caregiver Toolkit, this includes a policy template, sample waiver, and sample letters.

12/23/20: CDC LTCF Toolkit is LIVE: The LTCF Toolkit is meant a resource for explaining COVID-19 vaccination to both residents and staff in LTCFs. It includes resources for talking with staff, residents, and families, FAQs on the vaccines, and tips on how to prepare staff and vaccine safety monitoring and reporting.

12/23/20: New Vaccine Information from CDC: The CDC has now posted a variety of materials for the general population on the COVID vaccines. The materials include "8 Things You Need to Know About the COVID-19 U.S. Vaccination Program," "When Vaccine Supply is Limited, Who Gets Vaccinated First?," "What to Expect at Your Appointment to Get Vaccinated for COVID-19," "Benefits of Getting a COVID-19 Vaccine," "Different COVID-19 Vaccines," and "Ensuring the Safety of COVID-19 Vaccines in the United States."  They have also posted these printable stickers that can be used when you and your residents receive vaccinations. 

12/23/20: CDC Information on Pfizer Vaccine: CDC released an information quick-sheet on the Pfizer COVID-19 vaccine yesterday, available here. You can find info about the vaccine itself, the side effects associated with the vaccine, and demographic information from the clinical trials. This guide also provides a link to how COVID-19 vaccines work.

12/23/20: CDC Information on New Variant of SARS-CoV-2 Virus: Based on mutations, this new variant strain has been predicted to potentially be more rapidly transmissible than other circulating strains of SARS-CoV-2. Although a variant may predominate in a geographic area, that fact alone does not mean that the variant is more infectious. Scientists are working to learn more about this variant to better understand how easily it might be transmitted and whether currently authorized vaccines will protect people against it. At this time, there is no evidence that this variant causes more severe illness or increased risk of death. Information regarding the virologic, epidemiologic, and clinical characteristics of the variant are rapidly emerging. CDC, in collaboration with other public health agencies, is monitoring the situation closely. CDC has released information on the new variant identified in the UK recently. The science-heavy information is available here. General information that can be used for addressing staff or resident questions can be found here. LeadingAge will share new CDC information as it becomes available.

12/23/20: Miss the Hour with CVS on the LTC Pharmacy Partnership?  Hear the Recording: A team from CVS Omnicare joined LeadingAge and more than a thousand callers yesterday to explain the Pharmacy Partnership in greater detail. CVS reviewed the specifics of consent forms, clinic scheduling, responsibilities of CVS and providers and explanatory resources available on their webpage. The session was recorded and LeadingAge also posted a detailed article for members.

12/23/20: LTC Pharmacy Partner Information

Walgreens:

CVS:

  • All facilities in NEBRASKA who are partnered with CVS should have received outreach by 12/14.  If you have NOT, either they don't have your updated contact information or the email is in their spam or junk mail. The email scheduling should be being followed up with phone calls from us as well. If a facility has not either received an email or a phone call from CVS Health, they should be prompted to take the following action:
  • Visit the vaccine clinic homepage and update the facility contact information: https://www.omnicare.com/covid-19-vaccine-resource

Community Pharmacy

12/23/20: Pfizer Vaccine Resources: Additional information and resources have been posted specific to the Pfizer vaccine including the EUA Fact Sheets translated into different languages.  Please see below for additional information: 

12/23/20: Provider Relief Reporting Likely to be Delayed: The new approach in the COVID Relief bill on PRF allowing providers to once again compare budgeted to actual revenues to calculate lost revenue, we are told will likely delay the PRF reporting. You will recall the reporting portal was scheduled to open in January but HHS now must incorporate changes from the COVID Relief Bill on lost revenue, as these will impact what is reported. LeadingAge expects updates to the HHS FAQs and reporting requirements to reflect and clarify the new approach. For more detail on all the PRF items in the bill, here is a LeadingAge summary.

12/23/20: Deadline approaches for Service Coordinator CARES Act Spending: As grant-funded Service Coordination programs receive initial approval from HUD for extra COVID-19 payments, HUD-assisted housing providers need to complete spending before the end of the calendar year. Following initial application approval, next steps for grant-funded Service Coordinators receiving CARES Act payments include the submission and approval of a spending plan; although providers have 20 days to submit their plan for HUD approval, expenses for additional COVID-19 costs incurred by the Service Coordinator needs to have occurred prior to the end of the performance year (December 31st). Specifically, in order to be included on CARES Act payment spending plans, expenses for COVID-19 costs need to have taken place between March 27th, when the CARES Act was enacted, and December 31st. Funds can continue to be drawn down from eLOCCS until January 31st, 2021. LeadingAge is working with HUD to bring clarity to the timeline; in the meantime, members are submitting spending plans for expenses that have already occurred or that will occur before the end of the calendar year. To review a list of eligible expenses, please see HUD's instructions for CARES Act payments to grant-funded Service Coordinators. More information will be available here.

12/23/20: Member Solutions for COVID Vaccination: LeadingAge has compiled a listing of member solutions to workforce-related vaccination challenges, and the link will be available here. Core areas featured include questions over whether and how to require, incentivize, or motivate staff to get the vaccine; pragmatic considerations such as worker's compensation and staff callouts due to side effects; and education approaches and resources for staff. 

12/23/20: Deadline approaches for Service Coordinator CARES Act Spending: As grant-funded Service Coordination programs receive initial approval from HUD for extra COVID-19 payments, HUD-assisted housing providers need to complete spending before the end of the calendar year. Following initial application approval, next steps for grant-funded Service Coordinators receiving CARES Act payments include the submission and approval of a spending plan; although providers have 20 days to submit their plan for HUD approval, expenses for additional COVID-19 costs incurred by the Service Coordinator needs to have occurred prior to the end of the performance year (December 31st). Specifically, in order to be included on CARES Act payment spending plans, expenses for COVID-19 costs need to have taken place between March 27th, when the CARES Act was enacted, and December 31st. Funds can continue to be drawn down from eLOCCS until January 31st, 2021. LeadingAge is working with HUD to bring clarity to the timeline; in the meantime, members are submitting spending plans for expenses that have already occurred or that will occur before the end of the calendar year. To review a list of eligible expenses, please see HUD's instructions for CARES Act payments to grant-funded Service Coordinators. More information will be available here.

12/21/20: Need to Know Updates: Information tidbits from the past week (vaccine and non-vaccine related):

  • Per DHHS, BinaxNow Test card shipments are back.  A few weeks ago we spoke about the reduction in the BinaxNow test kit shipments that were coming in to DHHS from HHS, which in turn resulted in fewer test kits being available through DHHS.  As of the end of last week, standard shipments (plus more) started coming in to DHHS.  If you are in need of additional kits in order to due required testing, please reach out to Angela Ling with DHHS (angela.ling@nebraska.gov).  
  • Also on BinaxNOW Test cards- DHHS Licensure wanted to emphasize that test kits are NOT to be removed from the facility for use by family members or others of LTC workers.  The test requires an order as well as a report of the results for CLIA.  
  • A physician order is not required for COVID-19 vaccinations.  There was a report that a pharmacists order will suffice, and members should visit with their LTC pharmacy partner on this.  CDC FAQs for LTC  state that a standing order from a physician order is not required because the Public Readiness and Emergency Preparedness Act (PREP Act) authorizes State-licensed pharmacists to order and administer COVID-19 vaccinations that have been authorized or licensed by the FDA.  
  • The vaccine does not result in positive test results and testing will continue in LTC post-vaccination.

Other helpful resources/information:

  • If you are looking for a vaccine fact sheet for residents or family members, try the one prepared by AMDA. HERE is the link to AMDA's toolkit. The resources, including the fact sheet, is free but you do have to sign in to receive access.
  • If you are a LTC provider signed up with a LTC Pharmacy Partner and you have still not heard from the partner regarding your first clinic, you are not alone.  According to both Walgreens and CVS, they are only contacting providers a week ahead of clinic dates.  Walgreens representatives in a meeting with LeadingAge Nebraska this morning indicated that they believe it will take 4-5 weeks to get out and vaccinate all SNFs. CVS indicated that they are aiming for 3 weeks.  If you are working with Community Pharmacy, you have likely heard from them-they are planning to get to all SNFs within a one week time period. 
  • All representatives coming in as a part of the vaccination effort should use appropriate PPE and follow all infection control protocols.
  • If you have a SNF and ALF co-located and there are sufficient doses of vaccine allocated to your facility, the LTC partner (or local partner) may provide vaccinations to residents of both during the same visit, per NDHHS.
  • New today on the LeadingAge Nebraska website- Essential Caregiver Toolkit, this includes a policy template, sample waiver, and sample letters.

LeadingAge Vaccine FAQ Update - Includes EEOC & Consent: LeadingAge continues to update the  FAQs daily.  Among other questions it includes updated guidance from the EEOC on what employers need to know about COVID-19 vaccines and the Americans with Disabilities Act.  Although it lays out what providers need to follow if they institute a mandatory vaccination program, it did not answer the ultimate question of whether employers can mandate vaccines under the EUA provisions.  From what we are hearing from members, most providers plan to initiate a voluntary program because of all the requirements a mandatory program may entail as well as the workforce challenges and fears surrounding the vaccines. Here is the latest Q&A from the FAQ document.

Can employers mandate that employees get the COVID vaccine when available?  The federal government cannot mandate a vaccine under an Emergency Use Authorization. The EUA, however, is silent on whether an employer, state or local jurisdiction may require vaccinations. We will continue to monitor state level actions as well as any additional federal guidance as more information becomes available that provides clarity to this issue.

The EEOC updated its guidance - What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws - on December 16, 2020. The guidance explores the requirements and considerations if employers mandate COVID-19 vaccinations for employers. Unfortunately, it does not answer the question of whether a mandatory vaccination policy is allowed if a vaccine only has only FDA EUA approval. See EEOC Guidance.

Consent Update: Many providers have been asking for written evidence that Walgreens and CVS will accept verbal or email consent. They have updated their websites, forms, and FAQs to reflect this. Pharmacy partners emphasized the importance of having the Consent documents completed PRIOR to the time of your scheduled clinic in order to facilitate the clinic running in a timely manner.

12/21/20: Pfizer Vaccine Resources: Additional information and resources have been posted specific to the Pfizer vaccine including the EUA Fact Sheets translated into different languages.  Please see below for additional information: 

12/21/20: Vaccine Allocation Amounts: Last Friday, HHS published the week one allocations provided to states and jurisdictions. Operation Warp Speed is coordinating the delivery of the orders from states against the initial 2.9 million doses. The data for the initial week's allocations are currently available here. Each week on Tuesday, states and jurisdictions will be provided allocations available to ship the following week. States and jurisdictions will order against their allocation that week and direct OWS where shipments of the vaccine should be delivered. These allocations, and more related information, are located on the HHS COVID-19 Vaccines page.

12/21/20: Ventilation in Buildings: CDC Update: CDC updated information and tactics to improve ventilation in buildings. The webpage includes a list of ventilation interventions that can help reduce the concentration of virus particles in the air, such as SARS-CoV-2. They represent a list of "tools in the mitigation toolbox," each of which can be effective on their own.  Implementing multiple tools at the same time is consistent with CDC mitigation strategies and increases overall effectiveness. These ventilation interventions can reduce the risk of exposure to the virus and reduce the spread of disease, but they will not eliminate risk completely.

12/21/20: Johns Hopkins University, LeadingAge Release COVID-19 Courses for Assisted Living and Senior Housing Providers: The Johns Hopkins University, in collaboration with LeadingAge, has released two free courses designed for assisted living and senior housing communities on COVID-19 response strategies. Featuring LeadingAge national staff and provider members in lectures and guest interviews, the courses are designed to help staff at assisted living and senior housing communities learn how to develop and implement a pandemic emergency response. The free, self-paced courses were developed in partnership with the Baltimore City Health Department and cover emergency preparedness, infection prevention, and well-being policies to keep residents and staff safe in each type of setting.

The courses are available on Coursera.org: 

Strategies for Assisted Living Communities during COVID-19: https://www.coursera.org/learn/strategies-assisted-living-covid19

Strategies for Senior Housing Communities During COVID-19: https://www.coursera.org/learn/strategies-senior-housing-covid19

12/21/20: Monoclonal Antibody Pilot Project: Over 197 Nebraska LTC residents have received monoclonal antibody treatment (Bamlanivimab) as of today.  Remember you can access ordering and administering information HERE

12/16/20: CDC calls on COVID-19 Vaccine and LeadingAge FAQ: Much of the information from the Monday update regarding the summary of the CDC COCA calls from Sunday and Monday regarding vaccine has been placed in this LeadingAge article.  In addition, you can access the LeadingAge FAQ, which is being updated regularly HERE. Updated content includes additional insights and resources on vaccine safety and protocols as well as post-vaccine considerations for healthcare personnel and residents.  LeadingAge has designated a landing page to vaccine related information and resources, which can be accessed HERE.

12/16/20: CDC COCA Webinar on Post-Vaccine Adverse Events and Infection Control: CDC held a COCA webinar Monday on post-vaccine adverse events and infection control considerations. This included reporting through VAERS and V-Safe, as well as managing staff and residents with post-vaccine symptoms. This webinar is available here and the LeadingAge summary is available here.

12/16/20: CDC Guidance on Post-Vaccine Infection Control Considerations: CDC released 2 documents over the weekend to guide decision-making around post-vaccine symptoms:  Post-Vaccine Considerations for Healthcare Personnel and  Post-Vaccine Considerations for Residents. Key points:

  •  Clinical trials have studied whether people get sick, not whether they transmit virus to others. Even once individuals have been vaccinated, we will still need to use PPE and other source control measures (masks, social distancing, hand hygiene) to prevent transmission.
  • The Pfizer vaccine will not impact COVID-19 testing. A positive viral test (PCR or antigen) should be evaluated just the same as you would evaluate any positive test, regardless of vaccine status. A positive viral test result cannot be excused by the vaccine.
  • Some post-vaccine symptoms may overlap with COVID-19 symptoms. These symptoms include fever, chills, headache, fatigue, muscle ache, and joint pain. Symptoms that are consistent with COVID-19 and are not consistent with post-vaccine symptoms include cough, shortness of breath, runny nose, sore throat, and loss of taste or smell.
  • Post-vaccine symptoms develop within 3 days of vaccination (with Vaccine Day being Day 1) and resolve quickly. Most post-vaccine symptoms occur the day following vaccination.
  • Residents who develop any symptoms and have had prolonged exposure in the past 14 days to someone who was COVID-positive should be treated like a person showing COVID symptoms, regardless of vaccination status. Proceed with isolation, transmission-based precautions, and testing.
  • Residents who develop only symptoms that may be vaccine-related (fever, chills, fatigue, etc.)  within 3 days of vaccination and have not had prolonged exposure in the past 14 days to someone who was COVID-positive should be isolated in place and monitored, provided they are not showing any symptoms that are not likely to be vaccine-related (cough, shortness of breath, runny nose, etc). PPE should be used with these individuals until discontinuation of transmission-based precautions. If symptoms do not improve or fever does not resolve within 2 days, proceed with testing for COVID-19.
  • Staff who develop any symptoms and have had unprotected exposure in the past 14 days to someone who was COVID-positive should be treated like staff showing COVID symptoms, regardless of vaccination status. Proceed with testing and exclusion from work until criteria have been met for return to work.
  • Staff who develop only symptoms that may be vaccine-related (fever, chills, fatigue, etc.)  within 3 days of vaccination and have not had unprotected exposure in the past 14 days to someone who was COVID-positive may continue to work, provided they are not showing any symptoms that are not likely to be vaccine-related (cough, shortness of breath, runny nose, etc). If symptoms do not improve or fever does not resolve within 2 days, proceed with testing for COVID-19 and restrict from work.
  • Staff or residents who show any symptoms that are not likely to be vaccine-related, regardless of whether this is accompanied by symptoms that may be vaccine-related, should be managed like staff and residents showing COVID symptoms.

The guidance also provides considerations for evaluating test results, including when to follow up antigen tests with confirmatory PCR testing. Remember that these recommendations and considerations come from CDC and CMS has not issued any guidance at this time. LeadingAge Nebraska has been working with NE DHHS on clarifications to some of these questions, and at this point they are consistent with the information provided above. 

12/16/20: CVS Vaccine Consent Update: This morning, our LeadingAge Nebraska contact with CVS provided the following updated information on LTCF Vaccine Consent.  It was placed on the Omnicare website this morning.

A Few New CDC Updates

  • Older Adults: CDC updated information for  older adults who are at greater risk of requiring hospitalization or dying if diagnosed with COVID-19.
  • Interim Clinical Considerations for Use of Pfizer-BioNTech COVID-19 Vaccine 
  • What In-home Social Service Providers and Clients Need to Know about COVID-19:In-home social service providersinclude, but are not limited to, caregivers or aides, teachers or tutors, social workers, and resettlement agency personnel who visit the homes of their clients during the COVID-19 pandemic.
  • Toolkit for Shared and Congregate Housing: Guidance and tools to help owners, administrators, or operators of shared housing facilities make decisions, protect residents and staff, and communicate with public health officials.

12/16/20: HHS Increases and Begins Distributing Over $24 Billion in Phase 3 COVID-19 Provider Relief Funding: Today, Health Resources and Services Administration (HRSA) announced that it has completed review of Phase 3 applications from the Provider Relief Fund (PRF) program and will distribute $24.5 billion to over 70,000 providers. Up from the $20 billion originally planned, the addition of another $4.5 billion in funding is being used to satisfy close to 90 percent of each applicant's reported lost revenues and net change in expenses caused by the coronavirus pandemic in the first half of 2020. The U.S. Department of Health and Human Services (HHS) recognizes this pandemic has upended the health care system and caused significant financial hardships. These resources, along with previous distributions, have provided much needed relief. Payment distribution started today and will continue through January, 2021.

Click HERE for a link to the LeadingAge article outlining Phase 3 Provider Relief Funding.

In addition, if you missed the LeadingAge live webinar on Provider Relief Fund reporting, the recorded version is now available on the LeadingAge Learning Hub: Provider Relief Funds Reporting Requirements. 

12/16/20: Coronavirus (COVID-19) Update: FDA Issues New Authorization for the BinaxNOW COVID-19 Ag Card Home Test: Today, the U.S. Food and Drug Administration issued a new emergency use authorization (EUA) for the BinaxNOW COVID-19 Ag Card Home Test which is authorized for use by patients at home with a prescription. 

12/16/20: Monoclonal Antibody Pilot Project: Over 165 Nebraska LTC residents have received monoclonal antibody treatment (Bamlanivimab) as of today.  Remember you can access ordering and administering information HERE

12/14/20: *With vaccine starting to roll out this week, there is a great deal of information for providers.  This update features information related to vaccine.  Pfizer vaccine was received in Nebraska today and was administered in a number of Nebraska hospitals. 

Notes from COVID-19 Vaccine Clinical Partner Call

Sunday, December 13th, 2020: The Clinical Partner call from Sunday, December 13 provided detailed information about recommendations from ACIP.

Of note to LeadingAge Nebraska members:

  • Clinical guidance is coming shortly.
  • Vaccination Communications toolkit for healthcare providers can be found here. A LTC communications toolkit is expected yet this week.
  • What about informed consent? There is no informed consent required under the EUA, however there may be a consent required by your Pharmacy Partner.  The CDC strongly recommends that everyone document receipt of vaccine fact sheet in each patient's records. There will be informed consent like materials in LTC facility toolkit that we anticipate will be available in the coming week, that providers can use and adapt, and to document that residents did consent to receiving the vaccine.  Verbal consent is sufficient but will need to be noted on the consent for completed prior to vaccination.  Email consent is also permitted.  A copy of the email should be attached to the consent form.
  • Infection prevention and control recommendations for persons with post vaccination symptoms are now available here.
  • FDA is developing an algorithm for the triage of persons presenting for the vaccine. This will be posted shortly. Contraindications do not include people with allergies to environmental allergens, oral medications, or family history or anaphylaxis. Those people can proceed with vaccination. Additional details are summarized below.

Basics of the Vaccine: Pfizer COVID-19 Vaccine received EUA on December 13th for those 16 and older.

  • What is an mRNA vaccine? mRNA takes advantage of the process that cells use to make proteins in order to trigger an immune response.
  • Rigorously tested, phases 1, 2 and 3.
  • First vaccine to use this technology, but this technology has been studied for more than a decade.
  • The vaccine does not contain a live virus, making it safer to produce and administer.
  • mRNA from the vaccine does not enter the cell.

Overview of ACIP Recommendations: ACIP Recommends that when a vaccine is authorized by FDA and recommended by ACIP, health care personnel, residents of long term care facilities be offered vaccination in the initial phase of the COVID-19 vaccine.

Administration

  • 2-doses administered three weeks apart
  • 4-day grace period, 17-21 days, considered valid
  • If more than 21 days, should be given as soon as possible.
  • Efficacy of a single dose has not been evaluated
  • Not interchangeable with other vaccine products. Safety of a mixed product series has not been evaluated.
  • If two doses of different vaccine are administered inadvertently, no additional doses of either product are recommended at this time.
  • Vaccine should be administered alone with a minimum interval of 14 days before or after the administration of other vaccines

Vaccination of special populations: Persons with underlying medical conditions: Vaccine may be administered to those with underlying medical conditions who have no contraindications to vaccination, including those with increased risk of COVID-19.

Persons with HIV infection, or other immunosuppression medications might be at increased risk for COVID-19. They may still receive COVID vaccine, but should be counseled about the unknown risk profile of the vaccine.

Pregnant women - No data on the safety. Animal studies are underway. Studies in human are ongoing and planned. mRNA do not enter the nucleus of the cell. If a women is part of a group who is recommended to be vaccinated, she can choose to be vaccinated. Pregnant women and providers should consider the level of community transmission, the risks to her and potential risks to the fetus, the efficacy of the vaccine, the known side effects of the vaccine, the lack of data about the vaccine during pregnancy. Routine pregnancy testing is not recommended prior to administering the vaccine.

Breastfeeding women - No data on the safety of COVID Vaccines in lactating women or the effects on the breastfed infant. If a woman is breastfeeding and in a group recommended to be vaccinated, she may choose to be vaccinated.

Current guidance for pregnant and breastfeeding women agreed on in partnership with American College of OB and American Academy of Pediatrics. Theoretically there is not a risk, and so we recommend that pregnant women be given the option.

Patient Vaccine Counseling

  • Before, providers should counsel on local and systemic post vaccination symptoms.
  • Unless a person develops a contraindication, they should be encouraged to complete the vaccine series
  • Antipyretic or analgesic medications may be taken for treatment of post vaccine symptoms.
  • Two doses are required to receive high efficacy.
  • Public Health recommendations for vaccinated persons. 1-2 weeks following the second dose before the person is considered vaccinated.
  • No vaccine is 100% effective
  • Given the currently limited data, vaccinated persons should continue to follow all COVID-19 guidance

Precautions: Severe allergic reaction to any component of the vaccine is a contraindication to the vaccine. Appropriate medical treatment used to manage allergic reactions must be immediately available in the event.

Required Observation Times

  • 30 minutes - those with a history of an allergic reaction to a vaccine or injectable 
  • 15 minutes - all other patients

Questions and Answers:

Will receiving the vaccine change someone's PCR or POC test results? Prior receipt of the vaccine will not affect results of the PCR or POC tests. Antibody tests could be affected, positive test could indicate either vaccination or prior infection.

Should someone who previously had COVID infection be vaccinated? Yes. Vaccine should be offered to persons regardless of history of prior symptomatic or asymptomatic COVID-19. Data from phase 2-3 clinical trials suggest it is still efficacious.

Should someone who has a current COVID infection be vaccinated? Vaccination should be deferred until recovery from acute illness. No minimal interval between infection and vaccination. Persons with documented acute infection in the preceding 90 days may defer vaccination until the end of the 90-day period if desired.

Should someone who received plasma or monoclonal antibody treatment receive the vaccine? There is no data on safety or efficacy in combo with other treatments. Vaccination should be deferred to at least 90 days after the treatment to avoid potential interference.

Should those with a known exposure to COVID-19 be vaccinated?

  • People in the general community who have a known COVID-19 exposure should not seek vaccine until quarantine has ended to protect healthcare personnel.
  • For LTC and other healthcare personnel, and residents of LTC with a known COVID exposure, vaccine may be given before quarantine period is up. Employ appropriate safety protocols.
  • Those in other congregate settings - correctional or homeless, vaccine can be administered to those who have been exposed

Should those with a history of extreme anaphylaxis to non-medications be vaccinated? Yes, we do not have any contraindications or precautions that are not related to a vaccine or an injectable. Latex, pollen, animals, a food, etc. Where we have cautions is those who have had anaphylaxis to any vaccine or injectable. This means that we want those people to have a discussion with the provider, and to understand what may have happened, and understand what the reaction was really caused by, was it a severe allergic reaction, etc. They can still get the vaccine but should be counseled on the unknown risks of the vaccine. Recommend 30 minutes observation period for those with a previous reaction to a vaccine or injectable.

What if someone had a previous anaphylaxis to an ingredient of the COVID-19 vaccine? Can they get the vaccine? They should not be given the vaccine.A potential source of allergic reaction is the ingredient poly ethaline glycol (PEG). This ingredient is in some other injectable medications.We are being abundantly cautious about this question. We do not want people who have mild allergic reactions to be concerned about being vaccinated. The two individuals who experienced anaphylaxis after the COVID-19 vaccine had both experienced severe anaphylaxis to a vaccine in the past.There were no cases of anaphylaxis in the clinical trial.

Does this vaccine protect against transmission? This vaccine was evaluated to see if it protected individuals from the virus itself. It does not provide information about transmission of the virus to others. This is the reason we will continue to have guidance, washing hands, social distancing, even after vaccination. We will also continue with some guidance for quarantine even for those who are vaccinated. We do know this vaccine is very good at keeping you from getting the virus. Over the next several weeks we will evaluate transmission. The company has said during the FDA advisory board meeting that they would be doing this type of study. This involves taking vaccinated persons and doing nasal swabs regularly. We expect to know more in the coming weeks and months. Guidance will change as needed when we have more information to inform clinical guidance.

How do you recommend increasing vaccine confidence in healthcare workers? We appreciate this question. We know that there is a lot of hesitancy around this vaccine. That is part of the reason we are here today, to explain how these vaccines work, and how we are monitoring safety. Healthcare providers are one of the key ways we can increase vaccine confidence. If we can get all staff vaccinated, we will then have people who can talk about the vaccine with confidence and increase confidence for the entire population.

After getting vaccinated or giving the vaccine are there any requirements for follow up? The requirements under the EUA require that:

  1. All patients receive the patient FAQ sheet that Pfizer has available online
  2. All patients are provided a vaccine shot card
  3. All vaccinations given are reported to the vaccine registry. Knowing which product someone received is critical so we can ensure they get the same product in their second dose.
  4. If a patient has an adverse event it is required to report to the vaccine adverse event reporting system.

For a high level overview related to the Vaccination Program-From CDC: 8 Things to Know about the U.S. COVID-19 Vaccination Program.  

For the information that was shared during today's COCA call: What Every Clinician Should Know about COVID-19 Vaccine Safety.

12/14/20: LHD Contact List: Many of you have expressed frustration in trying to determine if you have been matched for the LTC Pharmacy Partnership.  Unfortunately, as of this update we do not have a finalized list related to that program. To help facilitate making the reach out to your Local Health District easier, here is a list of the contact information for a primary and a back up for each LHD, provided by Jeri Weberg-Bryce at NDHHS.  If your facility is not matched with a LTC partner, you should contact your LHD to assist with your resident and staff vaccination needs, as they will be receiving vaccine directly in the next week or two.

12/14/20: FAQs and Resources on COVID-19 Vaccines and Issues Surrounding Vaccinations: LeadingAge National has updated the FAQ and Resource Sheet based upon the calls from this weekend with CDC and the COCA call today.  HERE is the link to the often updated document.  The document includes links to a number of useful resources.

12/14/20: Exclusive for LeadingAge Members: Vaccination Toolkit: This set of tools is part of a series designed to assist leaders in preparing for the COVID-19.  The Vaccination Toolkit includes a Leadership Implementation Checklist which will guide leaders through specific topics for consideration when planning for the COVID-19 vaccination process as well as two training tools with speaker notes, to be used by your organization - providing vaccination overview and specific guidance needed. These tools are based upon current guidance and will be updated as the vaccination process continues to evolve.  

Tools and resources are for LeadingAge members only. You will need your email and password to access these documents through the my.leadingage.org.

12/14/20: Section 202 and the Pharmacy Partnership: LeadingAge has put together an article geared toward Section 202 affordable senior housing providers on the latest information about the Pharmacy Partnership for Long Term Care. For Section 202 providers participating in the PPLTC, the article reviews what you might be focused on, what new information might be most useful, and where can you look for additional information.

12/13/20: New resources from CDC:

New Vaccine Communications Toolkit These toolkits aim to give a variety of partners the tools and information to build confidence about the vaccine among those who will be first in line to get vaccinated.

COVID-19 Vaccine Considerations for Long-Term Care Residents and Staff

12/10/20: Vaccine Update- Breaking News: If you were able to join us for today's Member Call, we heard from Mackenzie Farr with Community Pharmacy related to the LTC Pharmacy Partnership and the Monoclonal (Bam) Antibody project.  I have arranged for representatives from Walgreens, CVS, Community Pharmacy and DHHS (Sara Morgan) to join us on a joint call with NHCA on Friday at 10:00 a.m. Link event info will be provided soon. We know that there are still a lot of questions out there on the LTC Pharmacy Partnership matching and how things will roll out that we hope to get some clarity on.

LeadingAge Nebraska heard from Sara Morgan this evening that the state will likely plan to start rolling out the Pfizer vaccine to skilled nursing facilities (Group A) through pharmacy partners the week of December 28 and beginning the week of January 3, 2021 for assisted living, congregate IDD, HUD 202s, etc. (Group B).  Sara also indicated that if you are not assigned a partner, you should reach out to your Local Health Department.  Based on information provided by the pharmacy partners, some facilities have not yet been contacted by the pharmacy that they are matched with (specifically Walgreens and CVS).  

Walgreens and CVS provided the following information that may be useful if you are assigned to them as a partner.  Community Pharmacy has been contacting their partners directly.

12/10/20: Bamlanivimab LTC Pilot (Monoclonal Antibody Treatment): During today's member call, Dr. Ashraf shared the Nebraska Monoclonal Antibody Treatment website. This is a new site and aimed specifically at helping you navigate the ordering and administration process and includes supporting resources.  Join us for the 11:00 Member call on Friday to hear more on this project from Dr. Ashraf, Dr. Lawler, Andrew Watkins, and Lisa Brand.

Bamlanivimab is a monoclonal antibody treatment option that is available to LTC residents. The treatment can be used for COVID-19 positive individuals who have symptoms that do not require hospitalization or additional oxygen beyond their baseline. The treatment is done by infusion and can reduce symptoms as well as reducing the necessity for hospitalization by around 70%. The Nebraska ASAP program through UNMC is helping to connect LTC providers with the drug as well as helping them facilitate someone to assist with drug preparation and infusion. 

12/10/20: Provider Relief Funds: Here is the short article Nicole with LeadingAge national wrote about the October incentive payments and this link to the list of providers who started receiving payments today. HHS has not agreed to review anymore nursing homes for the purpose of determining why they did not receive a September payment. Many answers can be obtained by reviewing the provider's data in the NHSN database. These data errors if uncorrected can continue to disqualify a nursing home from future incentive payments until corrected. We are also hearing that NHSN response time to inquiries is as long as 30 days due to the overwhelming number of inquiries.

12/7/20: Bamlanivimab LTC Pilot (Monoclonal Antibody Treatment): If you were able to join the ICAP call last Thursday or our member call last Friday you heard about the "Bam" Pilot Project for LTC.  Bamlanivimab is a monoclonal antibody treatment option that is available to LTC residents.  The treatment can be used for COVID-19 positive individuals who have symptoms that do not require hospitalization or additional oxygen beyond their baseline.  Great Plains hospital in North Platte has worked with the long-term care providers in their region, as well as others, to help facilitate delivery of th treatment.  The treatment is done by infusion and can reduce symptoms as well as reducing the necessity for hospitalization by around 70%.  The Nebraska ASAP program through UNMC is helping to connect LTC providers with the drug as well as helping them facilitate someone to assist with drug preparation and infusion.  Residents qualify for the drug, generally, if they meet the following requirements: 

  • 1) COVID+; 
  • 2) Symptoms;
  • 3) Symptoms not significant enough to require hospitalization; 
  • 4) Not requiring increased oxygen assistance (than their baseline).

If you have a resident(s) who meet these requirements, here is your next step:  FILL OUT THIS REDCAP FORM AND SUBMIT IT TO NE ASAP.  

You do not have to have existing plans in place to administer the drug in order to submit the form.  NE ASAP will assist you in pulling together those details is needed.  Here is a link to the ICAP presentation, which covers more specifics about the project and process, including ordering and administration information.

Nebraska has enough doses of the drug on hand to treat 1000 LTC residents through this program that are available for LTC use.  

12/7/20: Vaccine Update: Based on an update this morning provided to LeadingAge Nebraska by DHHS, the assignment of partners under the LTC Pharmacy Partnership is final.  I have updated information on partner matches.  If you have not heard from your Pharmacy Partner and you do not know your match or you did not sign up, please reach out and I can check the list for you.  

Toward the end of last week, based on ACIP recommendations, SNF was added to the priority 1A list for vaccine.  Sara Morgan shared today that this is the case and that they will be utilizing the Pfizer product (if approved) for the LTC partnership.  All partners (in Nebraska it is CVS, Walgreens and Community Pharmacy) will begin receiving vaccine through this program at the same time, meaning that none of those providers has been prioritized to receive vaccine ahead of another.  

If you know your partner, you can check out information that they are making available through their websites-

CVS: https://www.omnicare.com/covid-19-vaccine-resource

 Walgreens: https://pharmerica.com/covid19/

Again, per Sara Morgan with the DHHS Immunization program, it may be a few weeks before a sufficient supply to start administration under the CDC LTC Pharmacy program kicks in.  It is possible that healthcare providers may have access to vaccine as a part of earlier vaccine distributions.  If you have questions regarding your specific circumstances you can contact Jeri Weberg-Bryce with the NDHHS Immunization Program at jeri.webergbryce@nebraska.gov or (402) 471-2139.

LeadingAge national has provided this useful document which includes FAQs and Resources on COVID-19 Vaccines and Issues Surrounding Vaccinations(updated 12/7).  

12/7/20: How to Optimize NH Incentive Payments: The U.S. Department of Health and Human Serivces (HHS) issued Nursing Home Infection Control (NHIC) incentive payments for the September performance period and since their distribution in November, many questions have been asked about who received them, who didn't, how much was received and why? LeadingAge reached out to HHS on behalf of a sampling of our member nursing homes (including some Nebraska members) who didn't receive a September payment but believed they should have based upon the criteria of controlling the infections and minimizing deaths in their nursing homes. HHS recently provided some feedback on those issues that disqualified these nursing homes. Armed with this information and a look at these members' NHSN data, Nicole Fallon at LeadingAge has also gained a few other insights that members may find helpful as they attempt to optimize their opportunity to receive remaining incentive payments. We have really appreciated all of Nicole's work on behalf of our members. Read HERE for more information that may help moving forward.

12/7/20: CMS Webinar Series for Management on COVID-19 Prevention: Last week CMS announced a live Q & A series for clinical and administrative staff and others who have taken the longer QIO training CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management, hosted on www.QIOProgram.org.  Sessions in the live Q & A program will be held twice a month, on Thursdays from 4:00 - 5:00 Eastern, starting Thursday, December 10.  Here is the registration link.  Questions may be submitted in advance by email to: DVACSupport@thebizzellgroup.com. Questions not addressed during the live session will be answered on the QIOProgram.org FAQ Page.  

12/7/20: Star Quality Rating Unfreeze: CMS announced last Friday that the Five Star Quality Rating system will resume all updates with the January 2021 refresh. The health inspections domain has been held constant since April 2020 and various quality measures have been held constant beginning in June. With this update, all 3 domains will be unfrozen as of January. Recall that CMS also unveiled the new Care Compare site in September, which officially replaced all legacy sites, including Nursing Home Compare, on December 1, 2020. Complete updates to the Five Star Quality Rating system will be available at the new Care Compare site on January 27, 2021. More information on these updates and implications is available here.

12/7/20: Advance Care Planning Resources: In the face of COVID-19's latest surge, advance care planning is more important than ever. We've gathered materials and resources to help you have conversations with residents, clients, and patients who are at high risk for serious complications of COVID-19. Visit our Serious Illness, Grief, and ACP Resources page for trusted resources offering tools, tips, advice, and best practices focused on COVID-19.

12/7/20: HUD postpones 10-year PCN Due Dates: On December 4th, HUD published a memo with supplemental guidance for 10-year Project Capital Needs Assessments (PCNAs). Due to COVID-19, HUD had allowed the postponement of regular 10-year PCNA updates until September 30, 2020; because of continued difficulty conducting in-person CNAs, HUD will extend postponement of its regular 10-year PCNA to March 31, 2021, for properties with PCNA reports that are due between March 15, 2020, and March 31, 2021.

12/4/20: Essential Caregiver Program: Jenifer Acierno has been instrumental in the formulation of the program for LTC in Nebraska. Through her work with Becky Wisell with DHHS, this program will be available for LTC facilities in Nebraska going forward.

As a result of the global health pandemic, facilities have put barriers in place per state and federal guidelines on families and friends in order protect residents, who are among the most vulnerable to the COVID-19 virus, and staff. The Essential Caregiver Program reconnects long-term care residents with their personal caregivers, while continuing to prioritize safe care for all. It carefully balances the need to prevent COVID-19 in congregate settings with the strong desire for personalized care and meaningful social connections. The program is a voluntary program for facilities and there are requirements that they must follow. For example, participating facilities must have policies and procedures in place to implement the program. Essential caregivers must be screened and trained in the use of PPE just like facility employees. In addition, residents must be involved in the process of designating their essential caregiver. The guidance document for the Essential Caregiver Program can be found on the Nebraska DHHS website HERE.

This morning Dr. Ashraf confirmed that the 1000 doses of Bamlanivimab are on-hand for the LTC Pilot and that just a few doses have been administered so far.  Join the ICAP call at noon to hear about how to request and secure the monoclonal antibody for those residents who may qualify for the treatment.  The webinar will be recorded and available through the ICAP website after today.  We will be covering components of this process during the Member Call tomorrow as well.

12/2/20: Crisis Standard of Care Document: If you were able to join the member call today you heard about an overview of the Crisis Standard of Care document. The document is included HERE for your review.  While this is a document specific to hospital care and COVID-19, it is worth reviewing, as it also outlines prioritization for care and how that may impact those who you serve.

12/2/20: Testing Update:

Testing: Becky Wisell informed attendees during the member call this morning that there has been a reduction in the number of BinaxNOW test kits being distributed to the State.  DHHS is distributing the tests to Local Health Departments to be made available to providers.  Due to the decreased volume of tests being made available to DHHS, they are suggesting that the LHDs make access to the tests available specifically for outbreak testing.  Becky indicated that they were unaware of why the supply had decreased and that they are unsure when/if the supply will return to the previous quantities.  They had been receiving 25,000-35,000 kits per week previously, but in the past few weeks have only been receiving 8,000-10,000 test kits.  

Also, for LeadingAge Nebraska provider members, remember that the first phase of the COVID-19 Nursing Home Toolkit developed in conjunction with Pathway Health is available. The Testing Toolkit has 13 sections focusing on testing policies, learning and leadership, competencies, pre- and post-testing, outbreak investigation, swabbing collection, and billing. These COVID-19 Nursing Home Toolkits and Resources are for LeadingAge members only, and can be adapted as appropriate to reference relevant state laws or regulations.

12/2/20: Telehealth Update: CMS finalized the Medicare Physician Fee Schedule Rule yesterday

In the rule, CMS added more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the PHE. The permanent expansions made by the rule are limited to the pre-pandemic telehealth rules regarding geographic location and originating site - CMS is clear in the rule they cannot expand coverage beyond rural areas and to the home without Congress. The rule also contains provisions regarding professional scope of practice and supervision and payment for office and outpatient evaluation and management codes. More analysis coming soon.