*Updates are listed by date with the most recent listed first.
7/31/20: Announcement from LeadingAge National: Background: As we shared earlier this week, the U.S. Department of Health and Human Services (HHS) is considering a possible distribution of CARES Act Provider Relief Funds to private-pay assisted living/memory care providers that are stand-alone or part of a CCRC, located in the U.S states and territories. Argentum, ASHA, NCAL, and LeadingAge are assisting HHS in an effort to collect the necessary information from these providers through a private, secure data collection portal to help ease a potential future distribution of application funds. At this time, we have no guarantee such a distribution will happen, nor are we aware of an allocation methodology, if such a distribution were to occur. However, providing HHS with this data is an important step forward, and we appreciate your help in being responsive to their request. Providers should submit the relevant data into this portal by Monday, August 3 at 5 pm ET.
Data Submission Portal Information: Who is eligible to submit information?
We encourage private-pay assisted living and memory care providers that are stand-alone or those part of a CCRCs in the U.S. states and territories to submit their data. Please note that some states may use different terminology (e.g. personal care homes, supportive living facilities, etc.) to describe their licensed assisted living-type providers. All of these providers are encouraged to submit their information. For purposes of this portal, the term licensure also includes assisted living and memory care communities registered or certified by the state. Submitting your data does not guarantee you will receive or be eligible to receive a payment. You do not need to be a member of one of our senior living trade associations to participate in this secure and confidential data-collection effort.
What data must be submitted?
- Name of licensed/registered/certified assisted living and/or memory care community
- Name of entity that holds the license/registration/certification
- Community license/registration/certification number (some states may not provide a number)
- Corresponding Tax Identification Number (TIN)
- Taxpayer ID Number for the filing company
- Contact information for the person submitting data
- Include licensed assisted living that is part of a CCRC or a skilled nursing facility (SNF),even if the SNF has already received funding from the Provider Relief Fund.
Where do I submit the data? All of the above information should be submitted either manually or by uploading a specific file (see instructions for details) in the secure data collection portal. You will need to create an account. Please complete all the fields to ensure your submission will be accepted. Incomplete submissions will likely result in a delay in their inclusion.
What is the deadline to submit data? Please submit the requested data into the secure data collection portal by Monday, August 3 at 5pm ET.
Thank you for your quick action in support of this vital aid to our industry. If you have any questions, please contact us at: email@example.com
7/27/20: Testing in Nursing Homes: There is a CDC Clinical Questions about COVID-19 Q&A that addresses many of the questions that folks have been asking about what to do if a resident or healthcare provider declines a test or how to handle healthcare providers as they await their results. This Nursing Facility Testing Q&A may be helpful in answering those questions. For example:
- Q: How should handle residents who decline testing?
- A: Residents, or their medical powers of attorney, have the right to decline testing. Clinical discussions about testing may include alternative specimen collection sources that may be more acceptable to residents than nasopharyngeal swabs (e.g., anterior nares). Providing information about the method of testing and reason for pursuing testing may facilitate discussions with residents and their medical powers of attorney.
If a resident is asymptomatic and declines testing at the time of facility-wide testing, decisions on placing the resident on Transmission-Based Precautions for COVID-19 or providing usual care should be based on whether the facility has evidence suggesting SARS-CoV-2 transmission (i.e., confirmed infection in HCP or nursing-home onset infection in a resident).
Only residents who have a confirmed positive viral test should be moved to COVID-19-designated units or facilities.
The Q&A link includes similar information related to healthcare providers declining testing....
7/27/20: COVID-19 Testing Equipment: LeadingAge members in other states have shared that some have received testing equipment. Those who received equipment also received notification via email that included a letter from CMS. The data collected through the NHSN system directly supports this initiative by helping to prioritize the nursing homes with testing needs and an increasing number of cases. This FAQ is helpful and provides some level of detail on the plans to roll out this testing equipment.
7/27/20: HUD / HHS Will Host July 29 Telehealth Webinar: HUD, along with the HHS office of the Assistant Secretary for Preparedness and Response, the HHS Administration for Community Living, is hosting a July 29, 2- 3pm ET, webinar, "Telehealth for Community-Based Organizations: Services, Payment, and Partners." To register for the July 29 webinar, visit this page.
7/24/20: Public Health Emergency Extended: Secretary Alex Azar renewed the Public Health Emergency, effective Saturday, July 25. The extension will continue for 90 days or may terminate earlier if the Secretary determines the emergency has ceased to exist. The renewal of the Public Health Emergency will result in the Section 1135 waivers continuing, unless they are individually terminated by the department. The LeadingAge waiver document has been updated.
7/24/20: Deadline Extended Medicaid And CHIP Provider Relief Fund: The deadline for qualified Medicaid and CHIP providers to apply for the Medicaid & CHIP Provider Relief Fund distribution has been extended. The Centers for Medicare/Medicaid Services (CMS) set a new deadline of August 3, 2020. The Nebraska Medicaid program encourages providers to apply. Nebraska Medicaid has issued the following Provider Bulletin 20-26 with more information.
7/24/20: COVID-19 Testing Equipment: Health and Human Services (federal) recently announced that they will begin providing nursing homes with a Point of Care (POC) rapid response testing instrument. The data collected through the NHSN system directly supports this initiative by helping to prioritize the nursing homes with testing needs and an increasing number of cases. For the methodology describing how facilities are prioritized, and a listing of the facilities, please click here. This FAQ is helpful and provides some level of detail on the plans to roll out this testing equipment.
7/24/20: Care and Coping with Dementia and COVID-19: We have talked a lot about the impact of isolation on people with dementia during this time. In this 18-minute QuickCast, Teepa Snow discusses Positive Approach to Care (PAC) strategies to support people living with dementia when sheltering in place. Available free of cost to LeadingAge members and non-members.
7/24/20: Senior Housing and Nursing Facility Weekly Recaps from LeadingAge: LeadingAge recently started providing these very helpful Weekly Recaps for both Senior Housing and Nursing Facility providers.
7/22/20: CDC: Updated Guidance on Isolation and Precautions for Adults with COVID-19 and Return to Work for Healthcare Workers and Test Based Strategies: Monday's update included a fair amount of information related to CDC guidance showing a move away from test based strategies. LeadingAge developed this quick reference document . Dr. Ashraf has indicated that he will discuss the changes as a part of tomorrow's LTC call with ICAP. Tune in tomorrow for more specifics related to the Nebraska approach.
7/22/20: *PPE AVAILABLE* We still have a limited amount of PPE available. If you need face shields, surgical masks, or cloth masks, please email me at firstname.lastname@example.org and include the following information: Name and number of contact person, name and address of facility, what PPE you would like. PPE will be delivered or mailed depending on location.
We have a new opportunity for members who are interested in reusable gowns. Cornhusker State Industries (CSI) is a business affiliated with Nebraska Corrections. They have folks sewing gowns and masks. Please see examples below. They can only work with not-for-profits and have produced over 60,000 gowns so far. Gowns are made of orange twill material. Prices are listed below. The window mask does fog, so has to be treated with anti-fog spray or something similar.
Reuseable gown, sizes L ($9.85) and XL ($11.10) | Window masks-gray w/ tie string ($2.75), orange mask w/ tie string ($1.60)
IF you are interested in obtaining any of the items listed, please email me at email@example.com and provide a contact person name and number, items you would like and quantity and we will determine whether to submit an order.
7/22/20: Join LeadingAge to Urge Congress for Relief to Aging Services Providers: The House and Senate are back at work negotiating the next big relief package. We have been advocating this summer for our 5 essential actions and it's time to get it over the finish line.
Congress needs to hear how many LeadingAge provider communities are struggling to obtain enough personal protective equipment, sufficient testing, and resources to keep the older adults they serve safe and healthy.
The negotiations are happening now and decisions will be made fast. Send a personal message to your U.S. Representative and U.S. Senators asking for crucial resources and immediate relief today.
Send a message to Congress here: https://mobilize4change.org/ZCwNBav
7/22/20: Administration Announces New Resources to Protect Nursing Home Residents Against COVID-19: The President mentioned Nursing Homes in his press conference today. Here is the CMS press release.
7/22/20: Provider Relief Funds Reporting Timelines Announced: The U.S. Department of Health and Human Services (HHS) outlined the timeline for providers to report on their use of Provider Relief Funds(PRF), for those who received $10,000 or more across all PRF payments, in a new PDF document on its website. The first report will be due no later than February 15, 2021. See more in this article from LeadingAge.
7/20/20: CDC: Updated Guidance on Isolation and Precautions for Adults with COVID-19 and Return to Work for Healthcare Workers and Test Based Strategies: Information from CDC indicates that they may be moving away from test based strategies due the fact that some people have prolonged viral shedding and will continue to test positive after they are no longer contagious. In these cases the test based strategy is of limited use in deciding when people can return to work and for deciding when to discontinue transmission based precautions for new and existing residents.
CDC, in a memo entitled Duration of Isolation and Precautions for Adults with COVID-19, indicates:
- For most people with COVID, isolation precautions can be discontinued 10 days after symptom onset with symptom improvement and resolution of fever.
- For most people a test based strategy to determine when to stop using isolation and precautions is no longer recommended; for those who are immunocompromised, a test based strategy could be considered in consultation with infectious disease experts.
- For people who had symptomatic COVID and remain asymptomatic, retesting is NOT recommended within 3 months. Quarantine for these people is not recommended if they come in contact with someone who has COVID. However, these individuals MAY require retesting if they develop new symptoms.
In the memo entitled Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance), indicates:
- Except for rare situations, a test based strategy is no longer recommended to determine when to continue transmission based precautions.
- Transmission based precautions can be discontinued if the person has no fever for 24 hours and an improvement in symptoms after:
- 10 days after symptoms first appeared for those with mild to moderate illness who are not immunocompromised;
- 20 days since symptoms first appeared for those with severe to critical illness; and
- 20 days after the first positive viral test for severely immunocompromised patients who were asymptomatic
- Specifically related to discharge of patients to a nursing home or other LTC facility (e.g., assisted living), patients can be discharged:
- If transmission based precautions are still required, the patient should go to a facility that can care for COVID patients;
- If transmission based precautions are not required, the patient does not require further restrictions.
Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance) indicates:
- A test based strategy is no longer recommended to determine when to allow health care personnel with COVID to return to work.
- Health care personnel with severe to critical illness or who are severely immunocompromised can return to work 20 days after their positive test.
- Health care personnel with mild to moderate illness can return to work 10 days after symptoms first appeared and at least 24 hours since their last fever.
These are CDC guidance/recommendations. State and local health departments may adapt these to local circumstances. This potentially allows staff to return to work if they are no longer symptomatic, without testing required. CDC recommends that nursing homes no longer need a test based strategy to determine whether to admit individuals from the hospital.
See this article by LeadingAge for more information.
7/17/20: A note from Jenifer: Nursing Facility providers- ICAP is providing sound and reasonable assistance to many of you in relation to infection control challenges. Have you received a citation from DHHS surveyors when they do their infection control surveys when you are following ICAP guidance? I have heard from a number of you with these concerns and am collecting and sharing these examples with DHHS so they can evaluate these situations.
ALSO- if you have an example of being cited based on a QSO memo within the first few weeks that the QSO was issued and are willing to share, that would be great. It took a few weeks for the interpretation of the content of these memos to be made available. We have heard from the DHHS survey Interim Director that they have been providing an informal "grace period" during those time periods. Email me if you have examples that you would like to share. -Jenifer
7/17/20: HHS Announcement on Nursing Home Testing: As was included in Wednesday's update, HHS issued a press release that they plan to supply new, rapid point-of-care testing system to nursing homes. Instruments will roll out to hotspots first and it may take some months for the items to be available to nursing facilities. To be eligible to receive the antigen test machine a facility must have a CLIA certificate or a CLIA waiver. Nursing homes should begin the application process immediately to avoid any delays. CMS says that at this time, applications are processed within a few days. Here's the link CMS provided for how to apply: https://www.cms.gov/regulations-and-guidance/legislation/clia/downloads/howobtaincertificateofwaiver.pdf
7/17/20: Updated Provider Relief Document: I have been sharing the Provider Relief Document put together by LeadingAge over the past many weeks. This document was updated on Monday, so I am including it again for your review. Also, in conversation with Senator Fischer's staff a few weeks ago we were informed that the intent of the PPP SBA loans was to include both government owned hospitals AND nursing facilities. Originally, it was indicated that nursing facilities were not included in that option. *REVISION* If you are one of those facilities and you have not applied for those funds, you may want to reach out to your bank to discuss doing so. We are seeking additional clarification from Senator Fischer's office regarding eligibility of nursing facility providers.
7/17/20: SNF Quality Reporting Program Non-compliance Notices Issue-Reconsiderations Due Aug 18 *repeat: CMS has sent notices to SNFs if they are considered non-compliant with the SNF Quality Reporting program. If providers receiving this notice take no action, they will have their Medicare FFS rates reduced 2% beginning October 1. If providers wish to seek reconsideration of this status they must submit this information via email to CMS by August 18. Here is a link to the LeadingAge article that provides the details of this process and information on the restart of QRP data reporting.
7/15/20: HHS Announcement on Nursing Home Testing: As you may have heard over the past few days, HHS issued a press release and mentioned in a press conference on Tuesday plans to supply a new, rapid point-of-care testing system to nursing homes. The instrument can also be used for flu diagnostics. HHS plans to supply testing instruments and tests to all nursing homes in the country, beginning with 2,000 going out as early as next week to nursing homes prioritized by CMS. These prioritized nursing homes will be in current "hot spots". The rest of these allocations will be received in the following weeks. HHS states that this is a one-time procurement meant to augment current testing capacity. Once a provider runs out of the government-provided supplies, they can purchase additional supplies directly from the manufacturer. CMS held an open call this evening to further discuss this initiative with nursing home providers and here are some of the questions and answers from that call as provided by LeadingAge national:
- How will nursing homes be prioritized to receive the instruments and tests, both in the first hot-spot allocation and in subsequent allocations? CMS is looking at CDC epidemiology data, NHSN reporting data, and other information to determine how nursing homes should be prioritized. They intend to make their selection methodology public in the coming days.
- How long will the total distribution process take? This will be a "slow roll-out" taking place over weeks/months. A more precise timeline has not been finalized.
- Will these instruments and tests go to all nursing homes, or only CMS-certified nursing homes? Nursing homes must have the CLIA certificate of waiver to receive the instrument and tests. Nursing homes should begin the application process immediately to avoid any delays. CMS says that at this time, applications are processed within a few days. Here's the link CMS provided for how to apply: https://www.cms.gov/regulations-and-guidance/legislation/clia/downloads/howobtaincertificateofwaiver.pdf.
- When a nursing home runs out of tests, what will prices be like to secure more tests? How will we pay for tests? What steps will the government take to keep costs reasonable and to prevent scams and "counterfeit tests"? CMS will share information about how to pay for tests in the future, and will have CMS payment team available on future calls to answer provider questions. HHS is asking the manufacturers to communicate with nursing home providers to make purchasing additional tests an easy process.
- What kind of training on the use of this testing instrument will be available? What kind of technical support will be available? HHS will be working with the manufacturer to be sure that training and technical support is available and is being widely used.
- Understanding that this testing method will not replace other testing methods and strategies, will there be any guidance from CMS or CDC on how to prioritize the use of these tests? CMS will not direct providers on who to test or how to prioritize, other than to say that providers should use this allocation to meet CMS recommendations and state mandates for testing.
- We have heard concerns about false negatives associated with this test method. Will CMS or CDC issue guidance on steps to take to minimize false negatives or mitigate the implications of a false negative? HHS says the tests are "somewhere in the neighborhood of 85%-90%" accurate and this accuracy beats having to wait days for a result. Positives are about 99% accurate.
7/15/20: Member Call Today with Connie Vogt, DHHS: Thanks to those of you who were able to join us for the call this morning with Connie Vogt, DHHS Program Manager for LTC Facilities. Today Connie presented on the array of Infection Control surveys that are currently underway including the COVID-19 Focused Infection Control (FIC) surveys. Just when we thought that the Focused Infection Control surveys were going to be done by the end of July, now there is another level of survey being put in place. The COVID-19 FIC requires the survey team to perform on-site surveys (within three to five days of identification) of any nursing home with: 3 or more new COVID-19 suspected and confirmed cases in the since the last National Healthcare Safety Network (NHSN) COVID-19 report or 1 confirmed resident case in a facility that was previously COVID-free. State Survey Agencies are encouraged to communicate with their State Healthcare Associated Infection coordinators prior to initiating these surveys. Connie indicated that Dr. Tom Safranek is currently serving in this role. Here is the PowerPoint from today's call. It is clear that there will be more to follow. The PowerPoint also includes information related to POC, EPOC and DPOC.
7/15/20: Visitor Prep Sheet: LeadingAge has pulled together this Visitor Prep Sheet by reviewing the practices proposed in other states. It may be helpful to review as you consider your processes for visitors.
7/15/20: Updated Provider Relief Document: I have been sharing the Provider Relief Document put together by LeadingAge over the past many weeks. This document was updated on Monday, so I am including it again for your review. Also, in conversation with Senator Fischer's staff a few weeks ago we were informed that the intent of the PPP SBA loans was to include both government owned hospitals AND nursing facilities. Originally, it was indicated that nursing facilities were not included in that option. If you are one of those facilities and you have not applied for those funds, you may want to reach out to your bank to do so as the fund was reopened. ~Jenifer
7/15/20: Update on Rates from Jeremy Brunssen, MLTC Interim Director: During a standing call that we had earlier in the month with Jeremy Brunssen, Jeremy shared that the Medicaid team would be sending an email with NF providers (you may have received the note last week) that would provide additional specific direction on completing the Medicaid cost report in light of the current pandemic costs and funding streams. He indicated that the goal would be to help give directions for consistency for providers.
If you are an NF provider, you are aware that the nursing facility rate methodology went into effect for Nebraska on July 1, 2020. As a part of implementing changes to the methodology, going forward bed hold rates will now be paid at the resident's casemix rate, rather than the lower default rate. MLTC was unable to implement the necessary coding changes in time to implement that change by July 1, 2020 but anticipates that the change will occur in August and will be retroactive to the July 1, 2020 date.
7/15/20: CMS Extends Deadlines for HCBS Settings Rule: CMS extended many of the deadlines for the HCBS Settings Rule today. The final compliance deadline is now March 2023, and the heightened scrutiny deadlines are now July 2021. See the LeadingAge article HERE.
7/15/20: SNF Quality Reporting Program Non-compliance Notices Issue-Reconsiderations Due Aug 18: CMS has sent notices to SNFs if they are considered non-compliant with the SNF Quality Reporting program. If providers receiving this notice take no action, they will have their Medicare FFS rates reduced 2% beginning October 1. If providers wish to seek reconsideration of this status they must submit this information via email to CMS by August 18. Here is a link to the LeadingAge article that provides the details of this process and information on the restart of QRP data reporting.
7/15/20: *PPE AVAILABLE*: We still have a limited amount of PPE available. If you need face shields, mini hand sanitizers, surgical masks, or cloth masks, please email me at firstname.lastname@example.org and include the following information: Name and number of contact person, name and address of facility, what PPE you would like, your daily gown burn rate, and whether you have COVID + in your facility. PPE will be delivered or mailed depending on location.
7/9/20: LTC Testing Update and Resources (shared by DHHS 7/2/20): The LTC Testing Process continues to evolve, so we are providing you with updated information to help the testing process flow more smoothly for you. Copies of the following guidance documents can be found on the Testing website at the link below.
- Testing Instructions for LTC, Abbreviated Registration - these are the step-by-step instructions for completing the registration process which must take place at the time of specimen collection.
- Long-Term Care Baseline COVID-19 Specimen Packaging and Shipping - these instructions provide information on packaging the specimens for shipment to the CHI St. Elizabeth Lab.
Training resources, including a video demonstration of the nasopharyngeal swab procedure, are included on the Testing website as well. We suggest that you contact resources in your community such as hospitals, physician offices, pharmacists, or nurse staffing agencies if you need health care providers to assist with performance of specimen collection. http://dhhs.ne.gov/Pages/Post-acute-and-Other-Facilities.aspx
We recently learned that the browser being used for registering persons for testing must be Google Chrome. Many facilities were having issues with the registration process when using Internet Explorer or other browsers. Below is a link to the LTC Testing Registration Process. https://covid19testingne.co1.qualtrics.com/jfe/form/SV_cJa8ezYYRQfZRCl?short_assessment=true
CHI St. Elizabeth Lab in Lincoln, NE, is the only approved laboratory for the LTC Testing Project. Specimens should not be sent to other laboratories if using the LTC Testing process. Please ensure the courier being used is taking the specimens to the CHI St. Elizabeth Lab. A facility may transport the specimens to the CHI St. Elizabeth Lab instead of using a courier. The Specimen Packaging and Shipping Instructions outline the process that must be followed.
If your facility is in need of additional test kits beyond what was initially requested, please contact your Local Health Department to request additional test kits for urgent needs. We are working to provide an additional supply of test kits to the Local Health Departments to have on hand for these urgent requests.
From the desk of: Becky Wisell |DHHS Administrator II, DIVISION OF PUBLIC HEALTH, LICENSURE UNIT, Nebraska Department of Health and Human Services, OFFICE:402-471-0179 | CELL:402-610-5122 | FAX:402-471-3577
7/9/20: SNF EPOC's for COVID 19 Focused Infection Control Surveys and F884 (shared by Connie Vogt 7/9/20): We are starting to receive the EPOC (Electronic Plan of Care) for the COVID 19 Focused Infection Control Surveys and many of them are not meeting the CMS criteria specific to these COVID 19 Focused Infection Control Surveys. Please share this information with your SNF/NF facilities to develop acceptable EPOC's for both the Licensure unit and the CMS surveys that were conducted. Again we strongly encourage all of the SNF/NF facilities to be enrolled in EPOC.
The facilities need to:
A) Ensure the EPOC contains all of the elements outlined in the POC are documented in the EPOC
B) Ensure the EPOC contains the required information under Enforcement Remedies.
a. New in this process is the DPOC Directed Plan of Correction
i. The facility MUST complete the appropriate videos and submit documentation with the EPOC
For F884 Failure to report to the National Health Safety Network
A) These are posted in EPOC
B) These are generated offsite by CMS
From the desk of: Connie Vogt, RN, BSN, Program Manager - Office of LTC Facilities - Licensure Unit - Division of Public Health - DHHS, PO Box 94986, 301 Centennial Mall South, Lincoln, Nebraska 68509-4986, (402) 471-3324, FAX: (402) 471-0555
7/1/20: *PPE AVAILABLE*: As was shared yesterday, we were very lucky to get a large supply of gowns in for our members. We have enough to fill all requests that have come in so far and more. If you need gowns, surgical masks, or cloth masks, please email me at email@example.com and include the following information. Name and number of contact person, name and address of facility, what PPE you would like, your daily gown burn rate, and whether you have COVID + in your facility. PPE will be delivered or mailed depending on location.
7/1/20: HHS Announces Extension of Public Health Emergency by Tweet: The Public Health Emergency is set to end on July 25th. On that basis, LeadingAge sent a request to HHS Secretary, Alex Azar, requesting an extension. The HHS Assistance Secretary for Public Affairs tweeted that the PHE would be extended. We are currently unsure how that will impact the various 1135 waivers. When there is more formal/specific information on the potential extension, we will provide an update.
7/1/20: Testing Update for Today: If you were able to join us on today's member call, you probably heard that the testing roll-out has been a very bumpy process. I don't have much of an update to provide, other than both staff and residents register at the time of the testing. They cannot be pre-registered. It sounds like additional direction will be coming from Becky and Dan and will be posted on the DHHS website. I will let you know when we get additional information on that.
7/1/20: HUD CFO Issues CARES Act Plan: This week, HUD published a plan for the $12.4 billion in CARES Act relief funding appropriated for the agency in late March. The comprehensive plan discusses a response team assembled by HUD for CARES Act disbursement, communication efforts with stakeholders, and funds allotment for various programs. For senior housing, the plan says that the agency will make some of the $40 million in funds available to help owners experiencing significant operating cost increases and financial hardships as a direct result of COVID-19; for service coordinators, the plan states that HUD will focus the $10 million in CARES Act funds on grant-funded service coordinators, as opposed to both budget-based and grant-based personnel. More details for senior housing CARES Act funds are expected from the agency within 30 days.