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

6/26/20: DHHS Announces Community CARES- Coronavirus Relief Fund: Yesterday during his Press Conference, Governor Ricketts announced the CARES Coronavirus Relief Fund.  This fund provides options for three different ypes of grant funding available to specific 501(c)(3) organizations in Nebraska.  These funds are being made available to help offset lost revenues and increased expenses related to COVID-19.  Funding is open to 501(c)(3) Nursing Facilities, Adult Day Services, Assisted Living, Hospice and others.  Some providers types are specifically excluded, such as hospitals and units of local and tribal government.  Providers can apply for more than one grant type. You can view the details for each grant type HERE.  Application and instructions will be made available on the DHHS website. 

6/26/20: CMS FAQ on Visitation: In Wednesday's update you saw that CMS released an FAQ document on nursing home visitation. The LeadingAge article regarding is availableHERE.

6/26/20: CMS Memo on 5 Star Quality Rating System: Yesterday, CMS released nursing home memo QSO-20-34-NH that announces changes to the 5 Star Quality Rating System on Nursing Home Compare and the end of an 1135 waiver. Changes to the Nursing Home Compare Website and Five Star Quality Rating System:

  • Staffing Measures and Ratings Domain: On July 29, 2020, Staffing measures and star ratings will be held constant, and based on data submitted for Calendar Quarter 4 2019.
    • Also, CMS is ending the waiver of the requirement for nursing homes to submit staffing data through the Payroll-Based Journal System. Nursing homes must submit data for Calendar Quarter 2 by August 14, 2020.
  • Quality Measures: On July 29, 2020, quality measures based on a data collection period ending December 31, 2019 will be held constant. While certain quality measures will be held constant the quality measure rating will NOT be held constant.

More to come on this.

6/26/20: Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19): Today, CMS revised the Medicare FFS Response to Public Health article and shared it on MLN to add the section, "Skilled Nursing Facility (SNF) Benefit Period Waiver - Provider Information" and related billing instructions. All other information remains the same.  There have been a number of questions on how to handle and bill with the benefit period waiver. 

6/26/20: HHS Clarifies Provider Relief Medicaid Distribution Application Items: LeadingAge has provided this article related to the Medicaid Distribution Application.  The Department of Health and Human Services, through a series of webinar this week, has updated the FAQ document related to the new Medicaid Distribution application process as well as how providers should report revenue information.

6/26/20: Home Health Proposed PPS Rule: The proposed home health prospective payment rule was released yesterday. The rule would update the home health prospective payment system (HH PPS) payment rates and wage index for calendar year (CY) 2021 with a market basket update of 2.6%. This proposed rule also would make permanent the changes to the home health regulations regarding the use of technology in providing services under the Medicare home health benefit as described in the Medicare and Medicaid Programs; Revisions in Response to the COVID-19 Public Health Emergency interim final rule with comment period. 

6/26/20: Life Safety Compliance and 1135 Waivers: This article "Navigating 1135 Waivers Affecting Life Safety Compliance" is from LeadingAge's life safety consultants. It explains what is relaxed through 1135s and what providers must still comply with and how.  It also has a section on fire drills, which can be waived. Providers must document that they have a staff training program,  but there is no specific guidance from CMS about what the training must look like or how it is to be delivered.

6/26/20: DHHS Announces Community CARES- Coronavirus Relief Fund: Yesterday during his Press Conference, Governor Ricketts announced the CARES Coronavirus Relief Fund. This fund provides options for three different types of grant funding available to specific 501(c)(3) organizations in Nebraska. These funds are being made available to help offset lost revenues and increased expenses related to COVID-19. Funding is open to 501(c)(3) Nursing Facilities, Adult Day Services, Assisted Living, Hospice and others. Some providers types are specifically excluded, such as hospitals and units of local and tribal government. Providers can apply for more than one grant type. You can view the details for each grant type HERE. Application and instructions will be made available on the DHHS website. 

Essentially, there are three types of funding available:

6/25/20: Educational Videos, Procedures and Forms from DHHS Website

6/24/20: CMS Issues Nursing Home Visitation FAQ: Today, CMS issued a Nursing Home Visitation FAQ. A summary from LeadingAge will be available soon.  Here are a few highlights: CMS reiterates that generally, visitation is restricted until a nursing home enters Phase 3 of reopening recommendations. Some visitation may take place prior to Phase 3, such as outdoor visitation done with appropriate precautions. CMS also clarified that visitation in "compassionate care situations" is broader than end-of-life situations. CMS says that if in-person visitation by the ombudsman is restricted that the ombudsman must still be guaranteed access to the resident and the nursing home must help facilitate this access for other access, such as virtually or by telephone.

6/24/20: Testing Update for Today: If you were able to join us for today's member call, you probably heard Dan Taylor answer a number of questions related to testing. We are very grateful that Dan was able to join us and hope that he will be able to join us again next week. Dan provided the following TESTING KIT DELIVERY document. Take a look to see what day of the week kits will be delivered to your Local Health Department. 

In case you were unable to make one of the testing calls that DHHS held last week, or maybe you just want a review, here is the presentation: LTC Baseline COVID-19 Testing PowerPoint Presentation. One clarification, your baseline testing must occur within the 30 days prior to your entry to Phase III.  

If you have questions related to testing you can send an email to: dhhs.ltctesting@nebraska.gov

 6/24/20: NHSN Reporting Enforcement: Some members are receiving citations and CMPs related to NHSN reporting and are not receiving a warning letter that was set out in the process outlined in QSO-20-29-NH.  CMS has indicated that the warning letters were only provided in the early weeks of reporting and that they are no longer issuing warning letters for initial episodes of noncompliance. CMS recommends the IIDR process. CMS is unsure how long the IIDR process will take, but is open to reviewing and overturning fines when warranted and will reconcile CMPs that accrue for an overturned decision.

6/24/20: CMS Covid-19 Data and Highlights: With the first few weeks of reporting underway through NHSN, there has been a fair amount of data made available.  LeadingAge has pulled together initial impressions of what this data demonstrates in THIS ARTICLE. 

6/22/20: Medicare COVID-19 Testing Announcement: Medicare Coverage of COVID-19 Testing for Nursing Home Residents and Patients CMS instructed Medicare Administrative Contactors and notified Medicare Advantage plans to cover coronavirus disease 2019 (COVID-19) laboratory tests in nursing home residents and patients. This instruction follows the Centers for Disease Control and Prevention's (CDC) recent update of COVID-19 testing guidelines for nursing homes that provides recommendations for testing of nursing home residents and patients with symptoms consistent with COVID-19 as well as for asymptomatic residents and patients who have been exposed to COVID like in an outbreak. Starting on July 6, 2020, and for the duration of the public health emergency, consistent with sections listed below of CDC guidelines titled, "Interim SARS-CoV-2 Testing Guidelines for Nursing Home Residents and Healthcare Personnel," Original Medicare and Medicare Advantage plans will cover diagnostic COVID-19 lab tests and non-cover tests not considered diagnostic. * Viral Testing of Residents for SARS-CoV-2 * Initial Viral Testing in Response to an Outbreak * Recommended testing to determine resolution of infection with SARS-CoV-2 * Public health surveillance for SARS-CoV-2 Tests that are considered non-diagnostic are not covered.

6/22/20: Baseline Testing Timeframe *UPDATED FRIDAY*: Last week, we heard from DHHS that mandatory baseline testing of staff HAD to be accomplished within the 14 days preceding June 22nd to meet the requirements for staff testing for Phase III.  On Friday afternoon we were informed by DHHS that as long as your baseline testing was conducted in the 30 days prior to June 22nd (May 24 or after) you CAN use those testing results as your mandatory baseline for Phase III.  As a reminder, you must also meet the other requirements outlined in the Phasing Guidance to move to Phase III.  

6/22/20: PPE Available: LeadingAge Nebraska has been fortunate to get generous donations of funding or supplies for PPE for our members.  Donations continue to come in from local sewing groups, a sponsor through the University of Nebraska Omaha, Department of Gerontology, and others.  

We have mailed and delivered a large quantity of PPE. We have a limited quantity of the following on-hand currently:

  • Surgical masks
  • Cloth masks 
  • Face shields
  • Hand sanitizer 

Please reach out to me directly (jenifer.acierno@leadingagene.org) if you are in need of any of these items and we can deliver or mail them to you.  

6/22/20: Nebraska COVID-19 LTC Data

Facility TypeResidentDeathStaff
Skilled Nursing/Nursing Facilities (SNF/NF)45484375
Assisted Living (ALF)14420145
Total598104520
This data is CUMULATIVEData from Jun 8 through Jun 21
Numbers of Residents with COVID-19 Positive Status59837
Number of COVID-19 Related Deaths (validated count only)1042
Numbers of Staff with COVID-19 Positive Status52031
Total Number of Facilities Affected by COVID-1914212 (new facilities)
Facilities Where only Resident(s) Tested Positive for COVID-1970
Facilities Where only Staff Tested Positive for COVID-198511
Facilities Where both Resident and Staff Tested Positive for COVID-195012

6/19/20: Baseline Testing Timeframe *BREAKING NEWS*: In the past week, we heard from DHHS that mandatory baseline testing of staff HAD to be accomplished within the 14 days preceding June 22nd to meet the requirements for staff testing for Phase III.  This afternoon we were informed by DHHS that as long as your baseline testing was conducted in the 30 days prior to June 22nd (May 24 or after) you CAN use those testing results as your mandatory baseline for Phase III.  As a reminder, you must also meet the other requirements outlined in the Phasing Guidance to move to Phase III.  

6/19/20: Administration for Community Living Webinar on Technology and Social Isolation: On June 26, the Administration for Community Living/US Department of Health and Human Services, will host a webinar "Addressing Social Isolation through Technology Solutions," from 1:00 - 2:00 Eastern.  Majd Alwan and Scott Code of LeadingAge CAST will present. 

6/19/20: Advocacy Campaign: Act for Older Adults: LeadingAge continues to advocate for our provider members across the full continuum of care. LeadingAge national is ramping up advocacy work during June and July to ensure that Congress's next relief package includes support that's aligned with our Five Essential Actions for Older Adults.  Next Tuesday will provide opportunities to carry the message!

6/19/20: TODAY: Now we're asking every LeadingAge member organization to add its name to our COVID-19 legislative asks. Signing on takes just a few moments -- but will have incredible impact on Capitol Hill. Be sure YOUR organization is counted among supporters!

We hope that you will support these efforts. Together, we can influence this critical legislation and ensure that Congress delivers real relief for aging services providers and millions of older adults!

6/19/20: Reopening Resources Insights and Tools: When it comes to the full spectrum of aging services, there's no one way to approach reopening and recovery. We trust our providers to forge their own best path, and LeadingAge staff experts are developing articles and materials to help you make decisions.

6/19/20: COVID-19 Response Plan Confirmation Due Monday (6/22/20): As a reminder, if you are an NF or AL you need to complete your COVID-19 Response Plan by June 22nd (Monday).  When you complete your planning, you should keep a copy of it with your Emergency Preparedness Plan.  The plan should be made available at the request of your local health department or DHHS.  You should also send an email notification to DHHS.HealthCareFacilities@nebraska.gov indicating that you have completed your plan.  The email should include your facility name and license number.  You DO NOT need to submit the actual plan.

6/19/20: Pandemic Disaster Preparedness: FEMA has published an exercise starter kit for providers to update emergency response plans during the health crisis. The kit includes samples slides and discussion questions for providers across the continuum to adapt current hurricane (or other) disaster response plans to the pandemic.

6/19/20: PPE Available: LeadingAge Nebraska has been fortunate to get generous donations of funding or supplies for PPE for our members.  Donations continue to come in from local sewing groups, a sponsor through the University of Nebraska Omaha, Department of Gerontology, and others.  

We have mailed and delivered a large quantity of PPE. We have a limited quantity of the following on-hand currently:

  • Surgical masks
  • Cloth masks 
  • Face shields
  • Hand sanitizer 

Please reach out to me directly (jenifer.acierno@leadingagene.org) if you are in need of any of these items and we can deliver or mail them to you.  

6/17/20: Temporary Waiver of Prior Auth for Transfer: As a reminder to Nebraska Medicaid providers, the temporary waiver of prior authorization for the transfer of patients to certain facilities has expired effective May 31, 2020. The following transfers again require prior authorization:

  • Post-acute LTAC, acute inpatient rehabilitation, or skilled nursing facility;
  • Transfer to a new long-term care provider; and
  • Observation.

Additionally, prior authorizations for elective surgeries and therapies that expire June 1 and forward will no longer receive an automatic 90-day extension.

Please see Provider Bulletin 20-11 for more details.

6/17/20: Paycheck Protection Program Loan Forgiveness: LeadingAge has posted an overview of the Paycheck Protection Program's new EZ Application Form for forgiveness.  On June 16, the Small Business Administration and the Department of Treasury announced a simplified loan forgiveness application for PPP borrowers. The article provides information on the simplified application form.

6/17/20: Provider Relief Fund: HHS has posted links for a webinar that it is hosting about the Medicaid Targeted Distribution application process. See below for the registration links for the two webinar dates. As part of the registration process.

Join our webcast to learn more about the application process. Please pre-register to reserve a spot on your preferred date:

 6/17/20: Staff Vacations and Travel Considerations During COVID-19: As restrictions loosen and travel restrictions begin to lift around the country, members are tackling the question of what to do about managing the risk of staff (and resident) travel for vacation and other non-essential leave requests. LeadingAge provides a review CDC guidance, outlines a variety of member solutions, and discusses the legal and liability considerations as a part of these issues.

6/17/20: House Coronavirus Oversight Committee: The House committee overseeing the federal response to the coronavirus crisis is launching an investigation into the country's five largest for-profit nursing home companies, seeking details about their structure, executive compensation and preparedness for coronavirus.  The Committee also sent a letter to CMS criticizing the agency's response to COVID.  

6/17/20: Community Development Block Grant (CDBG) as Resource for Senior Housing COVID-19 Costs: Since March 27, state and local governments have received $3 billion of the CARES Act's $5 billion for COVID-19 relief from HUD's Community Development Block Grants program. Funds could be used for PPE, for meals and food, and for cleaning and disinfecting, among other uses.  Here's a link to an article about CDBG as a resource for senior housing COVID-19 costs. Contact your local housing or community development offices for more information.

6/17/20: Advocacy Campaign: Act for Older Adults: LeadingAge continues to advocate for our provider members across the full continuum of care. LeadingAge national is ramping up advocacy work during June and July to ensure that Congress's next relief package includes support that's aligned with our Five Essential Actions for Older Adults.

Today, LeadingAge launched the new advocacy campaign "Act for Older Adults." Members, residents, families, and everyday Americans are being asked to fight for older adults during this pandemic. LeadingAge sent a letter to Congress filled with robust and detailed asks, and members like you have already joined over 25 meetings with congressional offices. Over the next weeks, you can expect action alerts, sign-on letters, social media posts and other materials to help extend the campaign. We'll soon launch a new web page to house messages and materials.

We hope that you will support these efforts. Together, we can influence this critical legislation and ensure that Congress delivers real relief for aging services providers and millions of older adults!

6/17/20: Hospice Article Update:  The recent FAQs related to hospice have been updated. The update clarifies that hospices should only discharge patients if they have documented reasonable attempts and still have been unable to make a visit in person or using the telehealth waivers.

6/15/20: Governor Announces Phasing Plan for LTC: During today's press conference, Governor Ricketts announced a number of upcoming changes to DHMs across the state. He also announced the new Phasing Plan for Nursing Facilities and Assisted Living. Most counties (excluding Hall, Hamilton, Merrick and Dakota) are moving to Phase III on June 22nd. The four excluded counties will move to Phase II on June 22nd.  There are certain requirements for NF and AL prior to being able to move between phases that must happen before a NF or AL makes the move. Review in the attached Phasing Plan that was sent out by DHHS today for more details.

6/15/20: CDC COVID-19 LTC Infection Prevention and Control Strategies Webinar: Tomorrow CMS will hold their Clinician Outreach and Communication Activity (COCA) call. Presenters will discuss how to apply infection prevention and control guidance for nursing homes and other long-term care facilities as they continue to prepare and respond to COVID-19. 

Date: Tuesday, June 16 
Time: 1:00-2:00 p.m. CST
Webinar Link: https://www.zoomgov.com/j/1615543668

6/15/20: NHSN LTC Data Quality Webinar: The CDC will host a LTC COVID-19 Data Quality Webinar tomorrow, Tuesday, June 16 from 12:00-1:00 p.m. CST.   The CDC has been recording and posting all of their training videos on the COVID-19 LTC Module, so it is likely that the webinar will be posted to the site a few days following the webinar as well. If you would like to join the webinar, space is limited. Click here to register for the webinar. 

6/12/20: Update on Phasing Roll-Out: If you were able to join us for today's member call, you heard Dr. Anthone share that the plan for phasing should be available toward the beginning of next week. That is good news. More to come next week.  

6/12/20: Clarifications on the Medicaid Provider Relief Fund Distribution: During today's LeadingAge call, Senior Advisor to Alex Azar, Nick Uehlecke, indicated that the deadline for Medicaid providers to apply for Medicaid Provider Relief funds was extended to July 20 to be consistent with application time frames extended to other provider types. Mr. Uehlecke said that providers, like adult day centers, who had to close their physical site were still eligible to apply for funding. He noted that HHS is working to resolve issues related to Medicaid providers who are part of the same tax ID number as a Medicare provider that already received funds. Here is an article from LeadingAge with more information.  

6/12/20: Paycheck Protection Program Guidance Implements Flexibility Act- Rules Updated: The SBA issued an updated rule for PPP borrowers and potential borrowers following the Flexibility Act's passage. The Flexibility Act's key provisions include extending the time to use loan funds from 8 weeks to 24 weeks, reducing the amount of loan dollars to be used for payroll costs from 75% to 60% and extending deferral periods for repayment and, for new loans, maturity. For more information see this article from LeadingAge.

6/12/20: CMS Issues Non-LTC  FAQs:  On June 10 CMS issued and answered some new FAQs on Non-Long-Term Care Facilities and ICFs/IIDs.  Some hospice related issues are included.  See this article describing the hospice related provisions.  More to come related to the ICF/IID FAQs soon.  The FAQs indicate that is hospice staff have appropriate PPE and do not meet the CDC criteria for restricted access they should be let into nursing facilities to visit patients. 

6/12/20: NHSN Reporting Problems? If CMS is indicating that you still have not reported to NHSN and you think that you have, here is a tool that describes potential problems that may have occurred and how to solve them.

6/12/20: CMS Guidance on Resident Stimulus Checks: Yesterday, CMS put out a press release reminding providers that they can not seize residents' stimulus checks.  CMS indicated that seizing of checks is considered a violation of the regulation governing Freedom from Abuse, Neglect and Exploitation and that nursing facilities who seize checks could be subject to federal enforcement actions, including potential termination from participation in the Medicare and Medicaid programs. 

6/12/20: LeadingAge National 3-Minute Member Survey re: PPE LeadingAge is working very hard to address the issues of LTC and PPE on a national level.  They are working urgently to get a snapshot of the current state of personal protective equipment and testing among our membership. Please answer these fast questions to help assure the reality on the ground is reflected clearly in the media. 

6/10/20: HHS Announces new Targeted Medicaid/CHIP Distribution from Provider Relief Fund: Yesterday, HHS announced the next round of provider relief funding it intends to distribute.  This round is focused on Medicaid and CHIP providers.  The Application Portal opened today and will stay open until July 3rd.

Who is eligible? Providers who did NOT receive a General Distribution payment (these went to Medicare providers who may also provide Medicaid), provider who participate in Medicaid and/or CHIP programs AND who billed Medicaid FFS or Medicaid Managed care between 1/1/2018 and 5/31/2020.

How will providers get the payment? Under a new approach, providers must apply by submitting required information through a new "Enhanced Provider Relief Fund Payment Portal". HHS has said providers will need to submit annual patient revenue and # of Medicaid patients/beneficiaries served.

How much will a provider receive? HHS reports providers will be eligible to receive payments of at least 2% of reported gross revenue from patient care.

Here is an article covering from LeadingAge that covers this information. https://leadingage.org/regulation/hhs-announces-new-medicaidchip-distribution-provider-relief-fund-application-portal-opens

6/10/20: Long-Term Care Testing Plan- UPDATE: Testing plan OVERHAUL.  If you were able to join our member call today with Z. Winfrey and Connie Vogt you heard that the DHHS approach to baseline testing has shifted quite a bit since last Friday.  Last week, it was indicated that the testing process would start in Lancaster and Douglas counties.  That of course was concerning for providers located outside of those counties that would like to start phasing steps.  What we heard today is to expect an announcement by the end of the week regarding statewide testing that will be made available to NF and AL providers AND others who serve vulnerable populations.  This testing can be used as baseline testing for your staff.  If there has been a positive in your facility or staff come back positive this will result in resident testing as well. 

IF you have completed your own baseline testing with staff since the week of May 25, 2020 you can use this testing information for your baseline.  The information will need to be reported to DHHS.  More information will be rolling out related to the testing guidelines and availability by the end of this week.  If you have specific questions about testing at this point, you can contact Z Winfrey with DHHS.  Her email is zidarta.winfrey@nebraska.gov and her number is (402) 471-2736.  

Z indicated that there will be a daily presentation of the details for this new state wide Long Term Care Facility Baseline Testing Project starting on June 15 from 4:00-5:00 CT.  To join the Webex calls click HERE.  

Meeting access code: 145 603 4492 Meeting password: Qk5DvSdYM68

If you would like to schedule an individual call after attending one of the information sessions please Z at zidarta.winfrey@nebraska.gov to arrange that. As always, more information to follow.

Contact information for Zidarta Winfrey “Z”, Hospital Preparedness Program Coordinator Bioterrorism| Preparedness and ​Emergency Response| PUBLIC HEALTH
Nebraska Department of Health and Human Services
OFFICE: 402-471-1993   |   CELL: 402-560-1679 |    FAX: 402-471-2736 |    HOTLINE: 402-471-1983

6/10/20: Notice Process and Fines for NHSN Reporting: CMS Region 7 indicated today that it would be using the CASPER system to communicate deficiency notices and corresponding enforcement actions.  It was indicated that use of CASPER is necessary to automate the enforcement notice process due to the volume of cases and the given time frames.

CMS Region 7 indicates that they are aware of the systems issues that some providers have experienced and that they are in the process of reviewing these situations to ensure we have a process that is fair to providers. In  the meantime, providers who have received a CMP related to CDC reporting for circumstances beyond their control should submit an IIDR request to challenge the findings.

Requiring providers to submit an IIDR when the process was rushed and the ability to register providers was clearly challenged seems onerous for providers, but it seems that this will be the approach used for now.  The documents/emails that we discussed providers maintaining when encountering difficulty with registration or reporting should help with an IIDR.  Hold on to all of your exchanges related to difficulty with registration or reporting.

6/10/20: Nebraska specific data related to COVID-19 positive staff, residents, and facilities as of 6/9/2020

Facility TypeResidentDeathStaff
Skilled Nursing/Nursing Facilities (SNF/NF)40579317
Assisted Living (ALF)11719112
Total52298429
Numbers of Residents with COVID-19 Positive Status522
Number of COVID-19 Related Deaths (validated count only)98
Numbers of Staff with COVID-19 Positive Status429
Total Number of Facilities Affected by COVID-19122
Facilities Where only Resident(s) Tested Positive for COVID-198
Facilities Where only Staff Tested Positive for COVID-1975
Facilities Where both Resident and Staff Tested Positive for COVID-1939

6/8/20: DHHS Issues Urgent Memo re: N95 Vented/Valved Masks: The Department of Health and Human Services (DHHS) issued a letter today indicating that it has been notified that many health care facilities and services have received and are having staff use N95 "vented" (with valve) masks. All health care facilities and services must immediately stop the use of N95 "vented" (with valve) masks by both staff and residents/patients/clients. Included are examples of the types of N95 "vented" (with valve) masks that all health care facilities and services MUST STOP using immediately.

6/8/20: Annual Physical Requirements for Medicaid-Eligible Residents of Long-Term Care: Today, the Division of Medicaid and Long-Term Care issued Provider Bulletin 20-19.  This bulletin addresses the federal regulations that require that physician's visits occur every 30 days for the first 90 days from the date of admission, and then every 60 days thereafter. It provides that during the COVID-19 emergency, telehealth may be used for any of these physician visits. In addition, during the COVID-19 emergency, Nebraska Medicaid is waiving the annual physical exam requirement for Medicaid beneficiaries who are residents of long-term care nursing facilities.  Providers must still use their medical judgment to meet the specific care needs of long-term care nursing facility residents, whose circumstances in some cases may still require face-to-face visits. 

6/8/20: Long-Term Care Testing Plan- UPDATE: If you are a facility (NF or AL) in Douglas or Lancaster counties, you might have been contacted by DHHS to start COVID-19 baseline testing for your staff.  Based on your feedback, not everyone in those counties has been contacted. 

On last Friday's member call with Drs. Ashraf and Anthone you may have heard that if you are in a low-incident county, it could be a month or two before you are prioritized for testing under the DHHS plan.  If you have the option to test your staff or Test Nebraska is going to be in your community, it may be best to get a baseline sooner than later.  It was announced on the call that it could be over two weeks before a phasing plan is shared by Nebraska DHHS.  Of course, we are sharing our thoughts about the need for this to happen as soon as possible and to be facility specific.  In the meantime, you are working on developing your plan to loosen restrictions which is more challenging without the phasing document.  

Again, participation in this testing is not mandatory, but the state has verbally indicated that a  baseline is necessary to begin moving through the phases of reopening, in particular in relation to NF.  We are still reviewing the requirements for AL, but at this point the state has asked AL to proceed under the same approach as NF even though there has not been any directive issued requiring this.  More to come on this issue as research continues. 

6/5/20: Long-Term Care Testing Plan- UPDATE: If you are a facility (NF or AL) in Douglas or Lancaster counties, you have likely been contacted by DHHS to start COVID-19 baseline testing for your staff. Some of you may have already completed some portion of your testing already. You may have also heard during today's member call with Drs. Ashraf and Anthone that if you are in a low-incident county that it could be a month or two before you are prioritized for testing under the DHHS plan.  If you have the option to test your staff or Test Nebraska is going to be in your community, it may be best to get a baseline sooner than later. It was also announced on the call that it could be over two weeks before a phasing plan is put out by Nebraska DHHS. In the meantime you are working on developing your plan to loosen restrictions which is more challenging without the phasing document. That fact was shared again during today's call. 

Again, participation in this testing is not mandatory, but a baseline is necessary to begin moving through the phases of reopening, in particular in relation to NF.  The state is asking the same for AL as far as testing and phasing, but there has not been any directive issued requiring this.  More to come on this issue as research continues. 

6/5/20: NHSN Data and Infection Control Surveys: CMS released the full data from nursing homes' NHSN reporting yesterday. The data is available at data.cms.gov and there is a link to this data on the Nursing Home Compare site. Here is the CMS press release.

All data elements entered into NHSN are reflected for the reporting periods ending May 24 and May 31. You can also see if a nursing home did not submit data or if the data submitted did not meet validation criteria. The data file will be updated in 2 weeks and then on a weekly basis. 

6/5/20: Frequently Asked Questions COVID-19 Data Published by the Centers for Medicare and Medicaid Services: The Centers for Medicare and Medicaid Services (CMS) COVID-19 NHSN reporting requirements for nursing homes became effective on May 8, 2020. Data submitted to NHSN are shared with CMS on a weekly basis, enabling the agency to evaluate requirement compliance and publicly publish facility-level information. CMS memo QSO-20-29-NH provides additional information for nursing homes to meet COVID-19 reporting requirements. See these updated FAQs.

6/5/20: New Provider Relief FAQs Discuss Expenses and Lost Revenues: On June 4, the Department of Health and Human Services (HHS), in its recently updated Provider Relief Fund FAQ document, begins to offer more clarity on some long-unanswered questions regarding what HHS considers eligible expenses and lost revenues, for which a provider can use Provider Relief Fund payments. See the LeadingAge analysis here.

6/5/20: CARES Fund Ask for HUD Providers: President and CEO of LeadingAge, Katie Sloan, sent a letter to HUD Secretary Carson urging him to distribute critically needed COVID-19 relief funds to Section 202 Housing for the Elderly and Section 8 Project-Based Rental Assistance senior housing providers.  Funds were provided under the CARES Act but have yet to be distributed to these providers to help offset COVID related costs.

6/5/20: Cleaning and Disinfecting in Affordable Housing: LeadingAge has produced a new article that summarizes HUDs recommendations on this cleaning and disinfecting in Affordable Housing.  Most of the information comes from CDC and EPA guidance. HUD does have a new two-pager on how HUD multifamily housing owners should dispose of medical waste. The article also links to the recording of a HUD disinfection webinar.

6/5/20: Nursing Home Payment Project for Nebraska Department of Health and Human Services: The June 4, 2020 presentation is now available at http://dhhs.ne.gov/Pages/Nursing-Home-Payment-Project.aspx

6/3/20: Long-Term Care Testing Plan- UPDATE: We heard more today during our member call with DHHS and the National Guard about testing.  DHHS is planning to do a Pilot Project that starts with testing of all staff in NF and AL (or IL if co-located).  Emails should be coming to providers yet this week.  Testing kits will be provided by DHHS, PPE by local LHDs, and facilities can do on-site testing of their own staff.  There will also be options, if needed, for assistance with testing by the Nebraska National Guard or through Test Nebraska locations.  If you have a plan in place to facilitate testing already, the advice from DHHS was to move ahead with your testing.  The goal is to have all facilities in Douglas and Lancaster counties tested by the end of June.  The timing of the roll out for other counties is not yet known.  

IF there are facilities with known positives at the time of testing, there is the possibility that residents will also be tested at that time.  There is still more to come on this subject.  If you are a provider in Douglas or Lancaster county, you should start getting your staff listings put together.  This includes all staff.  DHHS will be reaching out soon.  Participation in this testing is not mandatory, but a baseline is necessary to begin moving through the phases of reopening.

6/3/20: New CMS Enforcement Memo Focuses on Infection Control: On Monday evening, CMS put out a memo (QSO-20-31-all), that includes updates on survey activities, enhanced infection control related enforcement, and quality improvement activities in nursing homes. 

CMS is anticipating that every nursing facility in the country will have an survey before the end of July 2020.  State survey agencies unable to complete all surveys by the deadline will have to submit a corrective action plan to CMS or face a 10% reduction in the State's CARES funding.  There will also be on-site infection control surveys for:

  • Nursing homes with cumulative confirmed cases at 10% of bed capacity;
  • Nursing homes with cumulative confirmed and suspected cases at 20% of bed capacity;
  • Nursing homes with 10 or more deaths reported due to COVID-19.

State survey agencies will be expected to increase infection control surveys significantly or risk losing CARES funding provided to the State.  

If you have not yet had your infection control survey OR you meet one of the on-site infection control survey requirements, you should be sure to get your Infection Control plan in order quickly!  Here are some good resources to help you.

CMS has indicated the the most frequent citations in infection control surveys have been related to hand hygiene and PPE use. LeadingAge has put together a VERY helpful document on this. A very worthwhile and succinct read.

According to the most recent CMS information for Nebraska from the end of May 2020, about 24.4% of nursing facilities in Nebraska had been surveyed.  

If you are interested in data, here is the CMS Nursing Home COVID-19 data by State as of June 1, 2020. 

Nebraska specific data related to COVID-19 positive staff, residents, and facilities as of 6/3/2020:

Facility TypeResidentDeathStaff
Skilled Nursing/Nursing Facilities (SNF/NF)38168290
Assisted Living (ALF)11519110
Total49687400
Numbers of Residents with COVID-19 Positive Status496
Number of COVID-19 Related Deaths (validated count only)87
Numbers of Staff with COVID-19 Positive Status400
Total Number of Facilities Affected by COVID-19114
Facilities Where only Resident(s) Tested Positive for COVID-195
Facilities Where only Staff Tested Positive for COVID-1972
Facilities Where both Resident and Staff Tested Positive for COVID-1937

6/3/20: Facility Care slides for June 3, 2020 call

6/2/20: Handouts for National Guard Testing Demonstration (For the June 3rd call): Captain Lisa Brand sent the following link to videos on the UNMC website that demonstrate the nasal swab technique.  She is not going to show the videos during the webinar, but asked that we share the link with members so they can view on their own.  There are no other handouts at this time.  Please share the link with appropriate staff within your organization.https://www.unmc.edu/iexcel/visualization/content-development/covid-19.html

6/1/20: Long-Term Care Testing Plan- UPDATE: If you were able to be on the member call with Dr. Anthone and Dr. Ashraf last Friday, you heard that Nebraska was in the process of implementing a testing plan for Long-Term Care.  In a call today, we were provided some additional information about next steps. 

WHAT WE KNOW:

DHHS has asked that IF you are an NF or AL (or IL if co-located with an NF or AL) and you are in Lancaster or Douglas County, please start getting together your staff listing as soon as possible. There will be more information coming out on where to submit this information in the next few days.

WHAT SEEMS TO BE PART OF THE PLAN:

  1. Testing will be focused on staff in long-term care facilities (NF and AL and IL IF co-located);
  2. Testing will be targeted, to begin with, in counties with higher incidence of positives and then by actual staff or resident positives;
  3. The staff baseline testing will likely be accomplished through Test Nebraska;
  4. Testing can be accomplished for AL or IL by National Guard, if needed;
  5. Facilities may be given an opportunity to conduct testing themselves and submit test media to Test Nebraska for processing-there will be more detail on this when available.

MORE to come on this subject, but the most important part of the message this evening is IF you are a LTC provider in Lancaster or Douglas County, get your staff listing together as you will be receiving a request for it from DHHS soon. 

6/1/20: National Guard Testing Demonstration: Our Wednesday Member call with Connie Vogt will be a little different this week.  We will be joined by representatives from the National Guard, including Captain Lisa Brand, who will be covering the COVID-19 testing process in an effort to help facilitate LTC testing in-house.  You will also have an opportunity to ask more detailed testing questions.

Wednesday, June 3, 2020 @ 10:00 a.m. CT  
 Join
:  https://zoom.us/j/96222516275 
Or call:  669-900-9128 
Webinar ID:  962 2251 6275

6/1/20: New CMS Enforcement Memo: This evening, CMS put out a memo that includes survey activities, enhanced infection control related enforcement, and quality improvement activities in nursing homes. 

LeadingAge national released a statement right away, with Katie Smith Sloan saying "today's data are a grim reminder of a slow motion tragedy that could have been averted if our federal and state governments had stepped up to provide leadership, coordination and funds that nursing homes need to save lives."  CMS will begin posting the still incomplete data to Nursing Home Compare this Thursday and update it monthly.

6/1/20: Update on Provider Relief Funds: Today HHS published FAQs related to Provider Relief Funds. Unfortunately, the FAQs do not provide any additional specific direction on whether providers must attest to the General Distribution Funds they have received by June 3 or 90 days after receiving the payment. HHS did slightly change the language on the website related to the June 3rd deadline to imply that providers who did not receive a second payment from the $50B General Distribution must submit their attestation to HHS through the Attestation Portal AND financial information through the General Distribution Portal by June 3 to remain eligible for the 2nd payment.  On this basis, LeadingAge is advising all Medicare providers who did not receive a second payment from the $50B General Distribution tranche to submit their attestation and financial information by Wednesday, June 3.

LeadingAge continues to obtain additional clarification from HHS on these issues and will share additional information if/when it becomes available.