*Updates are listed by date with the most recent listed first.
1/18/21: Need to Know Updates: Information tidbits from the past week (vaccine and non-vaccine related):
- Bamlanivimab-IF YOU have a resident who is positive, symptomatic, and is not on supplemental oxygen/more than their baseline O2, reach out to the Nebraska ICAP or ASAP team. Here is the Monoclonal Antibody page where you can submit a request.
- Last Friday you received a communication regarding an opportunity for Assisted Living facilities on how indoor visitation may be an option for AL (regardless of county positivity color) two weeks after 90%+ of residents and 90%+ of staff receive their second vaccination. Representatives from DHHS asked LeadingAge Nebraska to share the information with members last week. DHHS does plan to share direct communication to providers on this soon.
1/18/21: Provider Relief Fund Reporting Delayed-Portal Open for Registration: HHS announced the opening of the PRF Reporting Portal last Friday, but also noted that the reporting deadlines (originally, February 15) are delayed until further notice. In addition, HHS issued a revised version of the reporting requirements (last updated in November 2020) reflecting the required changes from the COVID Relief bill passed at the end of December. The most notable change being how providers can calculate lost revenues for PRF which now include the ability for some providers (those who had an approved budget on March 27,2020) to compare budgeted to actual; OR providers can use any other reasonable methodology with some associated documentation. With a new Administration coming in, LeadingAge and others are going to request further revisions to the reporting requirements to provide more clarity and address some of the unique situations for aging services providers including life plan communities that have yet to be addressed by the current requirements. There is no guarantee of further amendments to the reporting requirements but it is possible that further changes may occur. LeadingAge national put together an article on the current changes and developments announced last Friday.
1/18/21: New HHS FAQ on Phase 2 PRF Payment: HHS updated its FAQ document on Friday, answering the question several members have been asking "I applied for funds as part of Phase 2 of the General Distribution. Why have I not yet received a payment?" HHS answered: "Many applicants that believe that their organization has not yet been paid under Phase 2 have received funds that can only be accessed after setting up an Automated Clearing House (ACH) account. Organizations with revenue greater than $5,000,000 are required to set up ACH accounts to allow the Department of Health and Human Services (HHS) to most effectively and quickly deliver funds to providers, as well as maximize program integrity and fraud avoidance. For assistance in setting up an ACH account, please contact the Provider Support Line at (866) 569-3522 (for TTY, dial 711). Other applicants may have received Phase 2 funds in November or December that the applicant believes were part of Phase 3 of the General Distribution. Additionally, HHS has requested that a small number of applicants resubmit their application and financial information for data verification. In some instances, HHS has not received the requested resubmissions, and therefore, cannot adjudicate those applications."
1/18/21: Paycheck Protection Program Fully Reopens on January 19: On January 19, all lenders will have access to the PPP application portal, per the Small Business Administration. On January 14, the Small Business Administration announced that the Paycheck Protection Program (PPP) loan application portal will reopen to all lenders on January 19. Read HERE for more information.
1/18/21: Pharmacy Partnership for Long-Term Care Program for COVID-19 Vaccination FAQ: The end of last week CDC updated the PPLTC FAQs. For more information look HERE.
COVID-19 Vaccination: Healthcare Personnel and LTC Residents: Many of our member providers have shared that staff has hesitancy about receiving the COVID-19 vaccination. CDC has put together this resource to help communicate information and address concerns.
1/18/21: Rates of COVID-19 Among Residents and Staff Members in Nursing Homes: CDC released and MMWR on rates of COVID-19 among residents and staff members in nursing homes in the US. Rates of COVID-19 among nursing home residents and staff members increased during June and July 2020, and again in November. Trends in reported COVID-19 cases among nursing home residents and staff members were similar to trends in incidence of COVID-19 in surrounding communities. Increases in community rates might be associated with increases in nursing home COVID-19 incidence, and nursing home mitigation strategies need to include a comprehensive plan to monitor local SARS-CoV-2 transmission and minimize high-risk exposures within facilities.
1/18/21: COVID-19 Safety for CNAs Free Training Opportunity: LeadingAge Nebraska members have been given the opportunity, through our friends at LeadingAge Kansas, to take part in this free COVID-19 safety training for CNAs. We suspect the training will fill up quickly. To register or request more information visit www.surveymonkey.com/r/CNASAFETY or email email@example.com. You can also contact Natalie (firstname.lastname@example.org) with questions. Click HERE to download and view the training flyer. Thanks to LeadingAge Kansas for sharing this opportunity.
1/15/21: Important Information from DHHS Related to Visitation and Vaccine Rate for Assisted Living: DHHS has asked LeadingAge Nebraska to share this update with our members. If you are a licensed assisted living community, this applies to you. DHHS will be sending out an email pertaining to this to you directly as well.
Assisted living facilities with >90% staff AND residents vaccinated, will have the option to allow indoor visitation for vaccinated individuals two weeks after the 90% received the 2nd dose of vaccine in the series. This option for visitation will be available even for facilities in red counties (>10% community positivity). All other infection control measures must remain in place.
DHHS shared that they recognize the substantial need for assisted living facility residents to see their loved ones and hope this provides more opportunity for visitation and does so in the safest way possible, based on the best data available at this time. They also hope this provides incentive for vaccination, and might help boost immunity, further protecting a vulnerable population.
DHHS indicated that this option may be updated, as well as other recommendations, as we learn more about vaccine effectiveness.
Skilled Nursing Facilities are still required to comply with QSO-20-39-NH related to visitation, until CMS provides updated/new guidance.
1/14/21: Dr. Anthone, Chief Medical Office with DHHS Division of Public Health, has asked that this message from the U.S. Department of Health and Human Services be shared with the members of LeadingAge Nebraska.
IN NEBRASKA, IF YOU HAVE A RESIDENT OF LTC WHO IS COVID POSITIVE, SYMPTOMATIC AND DOES NOT REQUIRE ADDITIONAL OXYGEN (FROM INDIVIDUAL NORMAL BASELINE) YOU CAN ACCESS MONOCLONAL ANTIBODY TREATMENT HERE . PLEASE REACH OUT TO ICAP IF YOU HAVE QUESTIONS.
UPDATE MESSAGE: With 4,131 deaths from COVID in a single day this week, it would be a crying shame if treatments to save lives existed but were going unused.
Unfortunately, that's exactly what is happening. For patients over 65 or those with comorbid conditions diagnosed with COVID, treatment with a monoclonal antibody can keep them from getting really ill, becoming hospitalized, or dying.
Yet, 75% of the doses sent out across the country to prevent severe illness remain unused. Considering we are in a surge situation, with 23,000 dying in the last 7 days, this is absolutely terrible.
So, why aren't people getting this infusion treatment when it could save their life? Either they (1) don't know about it; (2) don't realize they need it until they are very sick; (3) are creeped out about the idea of getting a transfusion and delay; (4) or their provider did not know about it and/or did not make it available.
We are trying to fix this, but need your help sharing the information.
First, the facts: As of January 6, HHS had allocated more than 641,000 patient treatment courses to states and territories which subsequently directed delivery of the medicines to more than 3,700 locations. As mentioned, only about 25 percent of the treatment courses allocated have been used in authorized patient populations.
Second, HHS has created a web-based locator for COVID-19 outpatient treatment sites for monoclonal antibody therapeutics. The system helps doctors and patients find locations for COVID-19 outpatient treatment.
Third, HHS released a Resource for Monoclonal Antibodies Treatment.
Please share and save a life.
1/14/21: Vaccine Updates: As of January 13th, 29,380,125 doses have been distributed and 10,278,462 million people have initiated the vaccination. See daily vaccination data updates and state-by-state information here.
1/14/21: Testing: CDC Expands Negative COVID-19 Test Requirements to All Air Passengers Entering the United States: CDC issued an Order requiring all air passengers arriving to the US from a foreign country to get tested no more than 3 days before their flight departs and to provide proof of the negative result or documentation of having recovered from COVID-19 to the airline before boarding the flight. This Order will go into effect on January 26, 2021. View FAQs about this Order here.
Testing and International Air Travel: CDC has updated their guidance for international air travel. These CDC recommendations are based on the latest public health science to inform safer, more responsible international travel during the COVID-19 pandemic. Here's what to know:
- Get tested 1-3 days before your flight.
- Get tested 3-5 days after travel AND stay home for 7 days after travel.
- Even if you test negative, stay home for the full 7 days.
- If you don't get tested, it's safest to stay home for 10 days after travel.
- Always follow state and local recommendations or requirements related to travel.
- Delay your travel if you are waiting for test results.
1/14/21: Collaboration on SARS-CoV-2 Diagnostic Test to Distinguish Coronavirus from Influenza Infections: BARDA is providing funding, technical assistance and expertise to support the development of a combination diagnostic test for influenza A/B and COVID-19 to be developed by DiaSorin Molecular LLC. The new Simplexa™ COVID-19 & Flu A/B Direct assay will provide results in approximately 90 minutes and is performed using the company's LIAISON® MDX, a diagnostic platform currently used for their influenza and Respiratory Syncytial Virus (RSV) tests that have been cleared by the U.S. Food and Drug Administration (FDA).
1/14/21: HHS and DOD Purchase 1.25 Million Additional Doses of Regeneron's Antibody Therapeutic Treatment: HHS and DOD announced the purchase of 1.25 million additional treatment courses of Regeneron's investigational monoclonal antibody therapeutic, a combination of casirivimab and imdevimab, to be delivered in the first half of 2021 to treat non-hospitalized, high-risk COVID-19 patients. This latest agreement brings the total supply of casirivimab and imdevimab purchased by HHS and DOD to over 1.5 million treatment courses.
1/14/21: Launch of Three Additional COVID-19 Monoclonal Antibody Treatment Infusion Centers: HHS launched 3 temporary facilities in CA, AZ & NV to administer COVID-19 monoclonal antibody treatments. BARDA purchased Eli Lilly's product and has supported the development and purchase of Regeneron's product as part of our COVID response.
1/14/21: Integration of COVID-19 in Existing Acute Febrile Illness (AFI) Surveillance Systems: CDC updated their guidance on integration of COVID-19 in existing Acute Febrile Illness (AFI) Surveillance Systems. Key actions to reduce transmission of COVID-19, include active case finding, care and isolation, contact tracing, and quarantine. Acute Febrile Illness (AFI) surveillance systems are typically used to better understand common causes of fever.
1/14/21: PPE: How to Select, Wear, and Clean Your Mask: CDC has updated their guide on masks. CDC recommends that people wear masks in public settings, like on public and mass transportation, at events and gatherings, and anywhere they will be around other people.
1/14/21: Acute Hospital Care at Home Individual Waiver Only: CMS is accepting waiver requests to waive §482.23(b) and (b)(1) of the Hospital Conditions of Participation, which require nursing services to be provided on premises 24 hours a day, 7 days a week and the immediate availability of a registered nurse for care of any patient.
1/14/21: Travel: CDC updated their travel resource page, where you can find information about traveling internationally, when to delay travel, mask recommendations, and more.
1/14/21: FAQs for Traveling: CDC updated their frequently asked questions about COVID-19 and traveling.
1/14/21: Crew Disembarkations through Commercial Travel: CDC is allowing crew members to disembark from all cruise ships in U.S. waters with certain precautions. Cruise lines with complete and accurate response plans are able to use commercial travel to disembark crew members from certain ships if the ships meet certain criteria set by CDC.
1/14/21: ASPR Technical Resources, Assistance Center, and Information Exchange (TRACIE) Released Their Calendar Year 2020 Developed Resource Digest: Throughout 2020, the ASPR TRACIE Team has responded to hundreds of requests for technical assistance (TA) and gathering and sharing experiences and lessons learned from the field via a variety of products (e.g., articles, tip sheets, webinars, and tools) on COVID-19. This digest provides links to all the products created in 2020, many with the assistance of our Subject Matter Expert Cadre.
1/14/21: FCC Seeks Comment on New Emergency Broadband Benefit Program: FCC is seeking to provide broadband service and devices to low-income households. The Consolidated Appropriations Act of 2021 directed the FCC to create the program, which would reimburse participating companies for providing discounted broadband service and connected devices to eligible households during the COVID-19 pandemic.
1/14/21: Clinical Mitigation (Non-US Settings): CDC updated their toolkit on clinical mitigation strategies to ensure adequate provision of care for mildly to moderately ill COVID-19 patients, and delivery of other non-COVID-19 essential health services during the COVID-19 outbreak.
1/14/21: COVID-19 Information Metrics for Response Leadership's Decision Making (non-US Settings): CDC updated COVID-19 Information Metrics for Response Leadership's Decision Making. Information sharing among international and national stakeholders during the ongoing COVID-19 response is critical for a coordinated response. Emergency Management Systems Integration (EMSI) is the process of bringing together the public health programs, emergency management systems, and best practices into one cohesive system to enhance the prevention, detection and response to public health events.
1/14/21: Information for Community Health Works and Home-based Care: CDC updated information on Engaging Community Health Workers to Support Home-based Care for People with COVID-19 in Low-Resource Settings. Community Health Workers (CHWs) can support home-based care in low resource settings, including different actions CHWs can implement to support patients, their families, and their communities during COVID-19, and how to identify which people are eligible for home-based care.
1/14/21: Preventing COVID-19 in Retirement Communities and Independent Living: CDC updated their Guidance and Strategies for Retirement Communities and Independent Living to prevent the spread of COVID-19.
1/14/21: Nursing Homes and Long-Term Care Facilities Resources: CDC updated their COVID-19 vaccine resources for nursing homes and long-term care facilities.
1/14/21: COVID-19 and Pets: CDC updated their guidance and resources on what to do if you have pets.
- COVID-19 Trends Among Persons Aged 0-24 Years: CDC released an MMWR on COVID-19 Cases in Children, Adolescents, and Young Adults. In the MMWR they note that cases have increased since summer 2020, with weekly incidence higher in each successively increasing age group. Trends among children and adolescents aged 0-17 years paralleled those among adults. To enable safer in-person learning, schools and communities should fully implement and strictly adhere to multiple mitigation strategies, especially universal and proper mask wearing, to reduce both school and community COVID-19 incidence to help protect students, teachers, and staff members from COVID-19.
- COVID-19 May Invade, Damage Blood Vessels - Not Nerve Cells: NIH released a study in the New England Journal of Medicine on COVID-19 and blood vessel damage. The study found that COVID-19 symptoms such as headaches and "fuzziness" or brain fog that linger following recovery may be caused by damage to the brain's small blood vessels, not nerve cells.
- Blood Test Shows Promise for Early Detection of Acute Heart Transplant Rejection: Researchers have developed a blood test that could make it possible for doctors to detect - then quickly prevent or slow down - acute heart transplant rejection, a potentially deadly condition that occurs in the early months after a patient has received a donor heart. While current heart biopsies are only performed in hospitals, specimens for the new blood test can be collected at almost any commercial blood-collecting center. Since the blood test may lead to fewer biopsies, it could also provide significant financial savings. In addition, the noninvasive blood test may provide a potentially safer alternative to invasive biopsies during viral outbreaks like the current COVID-19 pandemic.
1/13/21: Reminder- The Friday joint Member Call has been combined with the Wednesday call moving forward. Join representatives from DHHS and ICAP on Wednesdays at 10:00am (CT).
1/13/21: Need to Know Updates: Information tidbits from the past week (vaccine and non-vaccine related):
- HHS Vaccine Distribution Shifts in Response to Need, Supply. Yesterday, HHS Secretary Alex Azar II announced in a press briefing the federal government is releasing the entire supply of vaccines it has on hand for order by states rather than holding second doses in physical reserve, is expanding groups getting vaccinated "because state restrictions on eligibility have obstructed speed and accessibility of administration," is telling states to expand the channels and access points for administering vaccines, and will change how HHS allocates doses to states in order to encourage states to support rapid vaccination and focus on the most vulnerable. Find a LeadingAge article here.
- The expansion of the groups getting vaccinated (65 and older and those with high risk medical conditions) was discussed on our LeadingAge NE member call today and was shared by Angela Ling (NE DHHS) during her vaccination briefing update yesterday. There will be more to come on this. You can view vaccine information on the State Vaccination Dashboard.
- Becky Wisell with DHHS shared during today's member call that surveyor testing is still being worked on. She also indicated that CMS Regional Office will be sending in federal survey teams to do "follow behind" surveys (as has been done in the past). There are no current timelines on when this will begin or how frequently it will occur.
- Connie Vogt shared that the survey team has been able to start catching up on annual surveys. This week we heard from members who would have been due for annual surveys in April 2020, who had surveyors in their buildings.
- In regard to TB testing, Dan Taylor with DHHS indicated that if timing becomes an issue with vaccination and TB testing (i.e. the TB testing cannot be done pre-vaccination) that it is okay to hold off on TB testing for the 4 weeks post-vaccination recommended by CDC. He said that a health history screening for TB should be completed upon admission (as would be done normally as a part of admission).
- Reminder- HHS revised instructions on POC testing and while indicating that NHSN reporting is preferred, it is not required. Submission of the HHS EPI spreadsheet to DHHS EPI DHHS.EPI@nebraska.gov is sufficient.
- Per Dr. Ashraf, there have been over 400 doses of Bamlanivimab administered in LTC. IF YOU have a resident who is positive, symptomatic, and is not on supplemental oxygen/more than their baseline O2, reach out to the Nebraska ICAP or ASAP team. Here is the Monoclonal Antibody page where you can submit a request.
- Per communication with our LTC Pharmacy Partners, the first round of vaccine clinics for LTC should be completed the week of January 18. For your second round of vaccine clinics:
- If you are partnered with Community Pharmacy you will not need a new consent form. There will be a screening form relevant to the day of clinic.
- If you are partnered with Walgreens or CVS you will need to complete a consent for for each vaccine.
1/13/21: LeadingAge Letter to Incoming COVID Team (federal level): Today, LeadingAge national sent a letter to the members of the incoming administration's COVID team regarding vaccinating aging services staff who work for providers not included in Pharmacy Partnership. The letter asks them to provide vaccination clinics targeting health care workers who work in home or community based settings (who are not included in the Pharmacy Partnership) and to develop a system for providers who serve people in these settings to be allowed to volunteer or be selected to help distribute the vaccine.
1/13/21: Provider Relief Fund Updates:
- The next round of Phase 3 payments are still scheduled to go out the week of January 25. Funds will continue to be distributed into February as application quality review is completed.
- HHS has still not issued Nursing Home Infection Control Incentive Payments for November or December performance yet. November payments are still pending OMB approval but once approved, are already scheduled to go out.
- Reporting Portal to Open but Reporting Deadline to be Delayed: The Reporting Portal is scheduled to open Friday, January 15 and members are encouraged to sign up once it opens. HHS has also said it will issue a formal announcement -hopefully yet this week - that the reporting deadline will be delayed (first report, originally, was to be due Feb 15). In addition, we expect revised guidance and FAQs to also be released in the next few days to align with the new requirements from the Congressional COVID Relief Package.
- Members with TIN validation issue: Nicole with LeadingAge national has heard from some of you that there are members whose TINs weren't validated through one or more of the General Distribution application processes - Phase 2 or 3. HHS has shared that LeadingAge will have an opportunity to submit these TINs and provider information to them as part of another validation process. A process will be set up for members to enter their data if they are having TIN validation issues. More information will be shared as it becomes available. If you are a LeadingAge Nebraska member and are having this issue, please contact Jenifer (email@example.com).
1/13/21: Quality Reporting Trainings: CMS announced new trainings today (that are not time sensitive) that are relevant to skilled nursing facility and Medicare home health members and quality reporting. The trainings are:
- From Data Elements to Quality Measures - Cross-Setting QRP Web-Based Training. The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides a high-level overview of how data elements within CMS patient/resident assessment instruments are used to construct quality measures (QMs) across post-acute care (PAC) settings.
- Section M: Skin Conditions - Assessment and Coding of Pressure Ulcers/Injuries Web-Based Training. The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides an overview of the assessment and coding of pressure ulcers/injuries.
- Section GG Web-based Training Course. The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course on how to properly code of Section GG.
1/13/21: Abbott BinaxNOW Training: Access the recording of the BinaxNow training, the Q&A session that took place at the end of the training with LeadingAge national, and the related article HERE.
1/13/21: LeadingAge to Host HUD, CDC on Vaccine Panel: Join LeadingAge on January 19 from 2:30-3:30 CT to hear from the CDC, HUD, and Section 202 providers about COVID-19 vaccine distribution clinics. For its Pharmacy Partnership for Long-Term Care Program, the CDC recommended states include HUD Section 202 communities as "long term care facilities" in their earliest vaccine distribution strategies as part of the Pharmacy Partnership. Vaccine clinics at HUD Section 202 communities, conducted by the CDC's pharmacy partners, have begun and will continue in the coming weeks. The January 19 vaccine forum for housing providers will feature remarks from CDC and HUD, as well as updates and insights from housing providers who have hosted vaccine clinics through the Pharmacy Partnership, followed by an audience Q&A. Register here to attend.
1/13/21: HUD Announces Competition for $150M New Section 202 Funds: This week HUD released the long-awaited competition details for $150 million in new Section 202 Supportive Housing for the Elderly funds. The application deadline is May 26. Expanding the supply of affordable housing is LeadingAge's top affordable housing policy goal. Here is an article about the funding competition.
1/13/21: LeadingAge Quarterly Housing Survey: Following up on our October 2020 survey of COVID-19 impacts on affordable senior housing, LeadingAge hopes that housing providers can fill out this quick pulse-check on vaccines, COVID testing, HUD payments, and more. The information collected helps LeadingAge national with advocacy at HUD and on Capitol Hill and helps determine the kinds of materials to produce for our housing members. Please take a moment and complete the survey.
1/13/21: Contact Tracing Professionals Share Tips for Housing Providers: This week's LeadingAge Housing Advisory Group (national) call featured researchers from the Hopkins Center for Global Health, who shared contact tracing tips for senior housing providers facing outbreaks at their communities. The call also featured insight from LeadingAge housing provider members who have conducted contact tracing at their communities through their own initiatives or in partnership with local health departments. The slide deck from the call, including risk reduction strategies and contact tracing considerations for housing settings, is available here.
1/11/21: Need to Know Updates: Information tidbits from the past week (vaccine and non-vaccine related):
- If you want to track progress day by day related to vaccine information, take a look at the State Vaccination Dashboard. The link includes information on doses distributed, administered, and the phasing. Here is a website from CDC that tracks COVID vaccinations by state and county, as well as by selected populations such as long-term care residents.
- Connie Vogt with DHHS, shared last week that some facilities are still sending the original (3 tab spreadsheet) to her and DHHS Health Care Facilities email. Facilities no longer need to do this, they only need to submit the DHHS EPI spreadsheet to DHHS EPI DHHS.EPI@nebraska.gov, your local health department and NHSN.
- LeadingAge Nebraska participated in a call with representatives from the Long-Term Care Pharmacy Partners and DHHS this morning. All three partners expect to have first round clinics completed by January 18. Second round clinics begin as early as next week. Between Community Pharmacy and Walgreens, there have been nearly 18,000 doses administered to LTC residents and staff.
- If you are a stand-alone Independent Living (not co-located with another level of care) and your circumstances dictate a need or an on-site clinic, please reach out to us and we can help advocate for that need.
- REMEMBER- no residents or staff will be charged for their vaccination. However, there is a need for insurance information (for administration purposes) by the pharmacies providing the vaccination. There has been some feedback that residents or staff are concerned in completing consent forms due to the need to provide insurance information. THERE IS NO COST TO RESIDENTS OR STAFF.
1/11/21: LeadingAge (national) Member Calls: Recognizing the significant role Medicaid plays in aging services, Jack Rollins of the National Association of Medicaid Directors will be with us on Wednesday, January 13 to talk about what to expect in states related to Medicaid policy choices over the coming year. So many ethical questions have arisen related to how vaccines are allocated and offered, questions about race and class, and about "who's on first." If you haven't signed up for update calls, you can sign up to join the call here.
1/11/21: LeadingAge and Abbott Training on BinaxNOW Testing Cards: Abbott will be hosting a training for LeadingAge and VNAA members tomorrow, Tuesday January 12 at 1:00 Eastern. The training will cover the Abbott BinaxNOW rapid testing cards, the affiliated NAVICA App, and the new at-home option for utilizing these tests. Register for the training here.
1/11/21: PPP Second Draw Article: Here is the article from LeadingAge on the PPP Second Draw loans, including the rulemaking from Friday: https://leadingage.org/regulation/paycheck-protection-program-second-draw-loan-information-aging-services. We expect the loan portal to open up this week or early next, so if folks are eligible and interested in a loan, we recommend starting that process ASAP.
1/11/21: CDC Shares Latest on Pharmacy Partnership, Reporting System: Today, the CDC told LeadingAge and a couple of other associations that first vaccine clinics have occurred or are scheduled at more than 12,500 nursing homes as part of the Pharmacy Partnership for Long-Term Care Program, and that there remain more than 800 nursing homes with which CVS, Walgreens, and state and local health departments are still trying to make contact. Policy staff also heard an update on the Vaccine Adverse Event Reporting System (VAERS), a reporting tool for vaccine side effects that pre-dates COVID-19. An article on these updates is here.
1/11/21: HHS Updates Point-of-Care Testing Reporting for Nursing Homes: You may recall LeadingAge sharing at the end of December changes in point-of-care testing reporting. On December 26, HHS walked back their requirement that nursing homes must report point-of-care testing to NHSN. This change did not eliminate the requirement for "labs" (including nursing homes) to report point-of-care testing data, but allowed for NHSN to simply be an option for reporting, with other options including a point-of-care testing platform and process established by your state. CDC updated the information on their site on December 28 (here). Around that time, HHS updated the Lab Data Reporting Guidance by eliminating the language related to NHSN reporting. On January 8, HHS issued a newly updated Lab Data Reporting Guidance document that more clearly reflects the change, as excerpted below:
- CMS-certified long-term care facilities may submit point-of-care SARS-CoV-2 testing data, including antigen testing data, to CDC's National Healthcare Safety Network (NHSN). This CDC- and CMS-preferred pathway to submit data to CDC's NHSN applies only to CMS-certified long-term care facilities. Test data submitted to NHSN will be reported to appropriate state and local health departments using standard electronic laboratory messages. Other types of LTC facilities may also report testing data in NHSN for self-tracking or to fulfill state or local reporting requirements, if any.
1/11/21: 1135 Waiver Reminder: The public health emergency (PHE) has been extended ahead of the January 20 deadline. Effective January 21, the PHE has been renewed for another 90 days. This means that the 1135 federal blanket waivers are also in effect for another 90 days. Review the 1135 federal blanket waivers here. You may have received a notice from CMS about a new tool, introduced today, for applying for 1135 waivers. To clarify, this tool is only needed when applying for an 1135 waiver at the state- or provider-level. 1135 federal blanket waivers DO NOT require application. More information on waivers and this tool are available here.
1/11/21: CDC Listening Session Today: LeadingAge national raised concerns during the CDC hosted a Listening Session for COVID Vaccination for Older Adults in the Community. LeadingAge brought forward many of the vaccination prioritization concerns that members have expressed, especially for those who serve independent living, affordable housing/ HUD, and HCBS populations. Ideas for new resources and support from CDC were solicited, and LeadingAge and other aging services associations provided examples and discussion.
CDC representatives were very receptive and interested in ideas for new resources and support. LeadingAge, ASHA and Argentum were especially vocal in providing comment, ideas and discussion on the topic; CDC promised to follow up with states, pharmacy partnership representatives, and attendees of the call. An article summarizing the call and points discussion will be available here.
1/11/21: CDC Updates Testing Guidelines for Nursing Homes: CDC updated guidelines for nursing homes to include information and guidance on the recently released Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing. You will recall that the "Options" guidance was released in early December and provided that quarantine for exposed individuals could be ended ahead of the recommended 14 days, if elected by local public health authorities based on local circumstances or resources. CDC recommended under the "Options" guidance that quarantine could be ended after Day 10 if no symptoms had been reported during daily monitoring, or after Day 7 with a negative diagnostic test and no symptoms reported during daily monitoring. In the updated Testing Guidelines for Nursing Homes, CDC stipulates that while the full 14-day quarantine period is preferred, nursing homes may consider the alternatives outlined in the "Options" guidance in order to "mitigate staffing shortages, space limitations, or PPE shortages." Remember that a provider should check with local public health prior to implementing these strategies.
1/11/21: CDC MMWR on Nursing Home Residents and Staff: CDC posted an early release of a Morbidity and Mortality Weekly Report (MMWR) entitled Rates of COVID-19 Among Residents and Staff Members in Nursing Homes - United States, May 25 - November 22, 2020. The report examines NHSN data on nursing home cases and HHS data on community prevalence for May through November 2020. Data analyses found that during the time period of May 25 - November 22, reported cases were comparable for residents (51.8% of all reported cases) and staff (48.2% of all reported cases).
Cases among residents and staff showed similar trends, increasing in June and July, decreasing in August and September, then increasing again in November. These trends were similar to population trends in the surrounding community. The report notes that while there were regional variances in cases and trends, in all regions, trends in nursing homes cases were similar to those of the surrounding community, suggesting that increases in community rates might influence nursing home rates. We knew this, and now we have it in writing in an official way.
The report recommends nursing home mitigation strategies include a comprehensive plan to monitor transmission in the surrounding community and minimize high-risk exposures within the nursing home. Notably, high-risk exposures include non-patient contacts among staff, including household and social contacts, with potential lapses in adherence to mask use and social distancing. The report presented the following strategies:
- Educate staff on the risk of community exposure.
- Ensure access to adequate PPE.
- Adhere to CMS guidance for routine testing of staff.
- Isolate newly admitted/re-admitted residents whose COVID status is unknown.
1/11/21: HUD Extends Service Coordinator CARES Act Payment Spending Deadline: The end of last week, HUD's Office of Multifamily Housing announced a spending deadline extension for CARES Act payments for grant-funded Service Coordinators. Originally ending on December 31st, the new period of performance for these grants is extended through March 31, 2021. This week, HUD plans to issue amendments to the Notices of Award for these grants, which will need to be approved by grantees in collaboration with Grant Specialists. More information here.
1/11/21: CALLS THIS WEEK:
Weekly Vaccine Update Call with DHHS: Tuesday, January 12, 2021 at 4:00pm CT
OPEN ONLY TO PROVIDER MEMBERS OF GROUP 1A (NF) and GROUP 1B (AL), State and Local Health, and Invited Associations.
Angela Ling will give a 30 minute update on Tuesdays regarding the status of vaccine roll-out and other efforts. If you cannot attend, meeting information will be disseminated to members of LeadingAge Nebraska through our Member Connections and these updates.
Join by phone: 1-415-655-0003 US Toll | Meeting number (access code): 145 758 0711 | Meeting password: jWrAjmu8W75
Weekly Connection with DHHS hosted jointly by LAN & NHCA: Wednesday, January 13, 2021 at 10:00 am CT
Or call: 669-900-9128 Webinar ID: 962 2251 6275
Nebraska ICAP Call: Thursday, January 14, 2021 at 12:00pm CT
Join the Nebraska ICAP team for the Weekly Long-Term Care call
*Join this week's call to hear more about the Essential Caregiver Program Join via Zoom: https://unmc.zoom.us/j/94892899060?pwd=WXZhQWxuOUpuNU5HZjZUMWJINWR0UT09
Friday Member Weekly Update Calls *Combined with Wednesday member calls moving forward. See Wednesday member call information above.*
1/6/21: Need to Know Updates: Information tidbits from the past week (vaccine and non-vaccine related):
- Per ICAP, remember that the COVID-19 vaccine should not be given 14 days prior to or following any other vaccination. When admitting a resident (or readmitting) be sure to check on whether they had a recent vaccination.
- Doug Hohbein from the State Fire Marshal's Office joined us for our member call this morning. He shared some concerns that he has identified and the related Power Point is available HERE.
- Dan Taylor mentioned during today's member call that he had shared guidance related to post-vaccine considerations for both staff and residents. This was included in a previously distributed update, but are included as document links below:
- If you have staff or residents who are ending their 90 day post-COVID phase, remember they should be moving back into your testing plans.
- Per Connie Vogt- Both NF and AL should continue to follow the visitation guidelines as set out by CMS in QSO 20-39-NH and testing requirements based on your community positivity rate.
1/6/21: CMS Revises QSO 20-31 ALL: On Monday CMS Revised QSO 20-31 All (as was reported in the Monday update). The changes addressed FICs, Life Safety, and Emergency Response. Changes can be viewed in RED. See the related LeadingAge article HERE.
1/6/21: Paid Sick Leave and FMLA Leave No Longer Mandatory: Effective January 1, 2021, federal law no longer requires an employer to provide paid sick leave and/or FMLA to employees affected by COVID-19. The Consolidated Appropriations Act signed into law on December 27, 2020, makes the leave provisions voluntary through March 31, 2021. Thanks to Marsha Greenfield with LeadingAge for this article. In addition, LeadingAge has updated its FAQs to reflect this change.
1/6/21: Register for January 12 LeadingAge and Abbott Training on Binax Now Testing Cards: Abbott will provide a training on Binax cards for LeadingAge and VNAA members on January 12 at 12 pm CT. The training will cover the Abbott Binax rapid testing cards, the affiliated NAVICA App, and the new at home option for utilizing these tests. Please register for the training here.
1/6/21: New CDC Vaccinations Count: Here is a website from CDC that tracks COVID vaccinations by state and county, as well as by selected populations such as long-term care residents.
1/6/21: CMS-CDC Fundamentals of COVID-19 for Nursing Home Management Live Q&A: This call will be the final live Q&A session in this series. The call will be recorded and available on the QIO site along with other sessions.
- Who should attend: clinical and administrative nursing home staff members who have completed the QIO training CMS-CDC Fundamentals of COVID-19 for Nursing Home Management
- When/where: January 7, 2021, from 3:00-4:00pm CT, Register here.
- Submit questions in advance via email to DVACSupport@thebizzellgroup.com.
Questions that are not addressed during the live session will be answered on the QIOProgram.org FAQ page.
1/6/21: LeadingAge Supports Proposal to Reduce Prior Authorization Burden: The Center for Medicare and Medicaid Services (CMS) proposed rules in early December 2020 that would require certain payers and plans to adopt new technology and processes to improve the prior authorization process through the use of Application Program Interfaces (APIs) and promote patient access to health information. They are part of a larger initiative to move the health care system toward greater interoperability, reduce provider burden and improve patient access to health information. LeadingAge offered its support for these efforts and some suggestions for additional improvements via the rule comment process. For more information see this article by Nicole Fallon with LeadingAge national.
1/6/21: Storing bulk PPE: Jensen Hughes, LeadingAge's life safety and emergency preparedness consultants have provided this advice on storing bulk PPE to avoid creating a hazardous area. The guidance offers specifications for existing spaces that are converted into storage areas.
1/6/21: TB Testing and COVID Vaccines: CDC has updated Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States. This guidance addresses a number of the frequently asked questions, such as dose intervals, mixing of COVID vaccines, mixing of COVID vaccines with other vaccines, allergic reactions and anaphylaxis, etc. We draw your attention to a piece about vaccines and TB testing, tucked neatly into the last section of the document title "Laboratory Testing". CDC recommends that individuals who have received a COVID-19 vaccine delay TB testing (tuberculin skin test or interferon gamma release assay) until 4 weeks after the completion of dose 2 of COVID-19 vaccination. Understanding that this may cause an issue with new hires and annual employee health certifications, we have reached out to CMS for further guidance. We are aware of at least one state that is pursuing emergency rule-making at the state level to issue a temporary waiver of timely TB test for those who have been vaccinated. More to follow on this as more is learned on the federal level.
1/6/21: Vaccine Town Hall for Assisted Living and Senior Housing Providers: Tuesday, January 12th, 11-12 CT: Join LeadingAge, Johns Hopkins School of Nursing and Public Health, and the Baltimore City Health Department for a town hall for assisted living and senior housing administrators, managers, and staff. The event will feature panelist updates and an audience Q&A to address the science behind vaccines, vaccination distribution, messaging strategies, infection prevention, and other vaccine updates. The event will feature Ruth Link-Gelles from the CDC's vaccine distribution Pharmacy Partnership program and Dr. Joshua Sharfstein from JHU, among others. Register here for the live event or view more information here.
1/4/21: Need to Know Updates: Information tidbits from the past week (vaccine and non-vaccine related):
- LeadingAge Nebraska was on a call with the LTC Pharmacy Partners this morning. The partners indicated that things have gone well with the COVID-19 vaccine clinics so far. When asked if there are things that facilities can do to help things go even more smoothly, here is what they mentioned:
- Make sure that the Consent forms are ready.
- Have arms ready, whether it is your arm or the resident's arm. Have layers removed so that the arm is easily accessible and vaccine ready.
- Make sure that you have a good estimate on the number of doses that you will need, especially when your vaccine contact reaches out to you the day prior. They thaw the vaccine based on those number and if they have an overestimate it leaves them scrambling for how, when and where to use the remaining doses. No one wants the vaccine to be wasted.
- Walgreens indicated that they believe their last "round one" clinics will be scheduled during the week of January 18th, assuming that their doses are made available as expected.
- Community Pharmacy indicated that they will finish "round one" clinics by the end of this week.
- CVS did not have an updated date for completion, but had indicated the goal of mid-January previously.
1/4/21: CMS Revises QSO 20-31 ALL: Today CMS released the revised criteria for QSO 20-31 All, requiring states to conduct focused infection control surveys due to the increased availability of resources for the testing of residents and staff and factors related to the quality of care. CMS provided updates to the Frequently Asked Questions related to health, emergency preparedness and life safety code surveys. More to follow on this.
1/4/21: ICAP Guidance:
- LTC Considerations: How to Handle COVID-19 Vaccine Clinics
- ICAP has put together this guidance for LTC facilities in considering how to set up your vaccine clinic (in-room vs. common area), observation, including information related to how to handle each color zone.
- Considerations for Interpretation of Antigen Results
- This flow chart algorithm is helpful in determining how to interpret antigen test results. ICAP adapted this algorithm from the CDC Antigen Testing guidance and it was updated 12.28.2020.
1/4/21: Toolkit for HUD Section 202 Providers in the CDC Pharmacy Partnership for Long Term Care Program: On December 30, LeadingAge national published a toolkit for Section 202 housing providers participating in the Pharmacy Partnership, based on the CDCs vaccine toolkit for Long-Term Care communities. The toolkit provides sample communications to residents about vaccine clinics, including a sample resident letter and survey, communication tips, and posters and stickers. The toolkit is available here.
1/4/21: PPP Second Draw Loan: PPP second draw loans are available to most organizations that received an initial PPP loan and can demonstrate a reduction in gross receipts of at least 25%. This article from LeadingAge details eligibility criteria and how members should proceed with the loans.