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7/29/21: Guidance on the new CDC Masking Directive - Source: Ruth Katz, Senior Vice President for Policy, LeadingAge National: LeadingAge participated in an invitation-only call for health and long-term care providers, convened in light of surging numbers of positive cases and the new masking guidance  released 7/27/19. "Much of the increase in spread of the Delta variant is driven by low vaccination rates, especially among health care providers," a CDC official said. Among the top points covered: 

  • The new guidance on masking is only guidance; it recommends that fully vaccinated people wear a mask indoors, reversing earlier guidance.  State and local jurisdictions will need to make their own decisions about whether to take action and what action to take.
    • No specific guidance from CDC around capacity of indoor spaces; that is up to the jurisdictions.
  • Vaccines remain the most effective defense against transmission. 
    • CDC "can't issue mandates at this time," but encourages providers and health systems to "move in that direction.  We encourage consideration of mandates."
  • Transmission of Delta variant
    • It is looking so far like viral loads with Delta are comparable for infected people who have been vaccinated or are unvaccinated.  Potentially, they may be equally likely to transmit the Delta variant virus.
  • Breakthrough infections.
    • Breakthrough infections are inevitable.  Anything - like the Delta variant - that increases transmission is going to increase the number of breakthrough infections.
    • So far there is no evidence of reduced vaccine efficacy with Delta.
    • CDC seems especially concerned about breakthrough infections in nursing homes where they are most likely to cause severe illness, hospitalizations, and deaths.
    • CDC is tracking breakthrough infections that result in hospitalizations and deaths, but for a variety of reasons not tracking the role of the Delta variant in all cases, especially not in asymptomatic infections.
    • They are working on new messaging about breakthrough infections.
  • Should providers change what they are doing?
    • None of the guidance has changed except masking.
    • CDC continues to recommend that exposed health care workers be tested and if positive, quarantine.
    • Today's guidance does not address mask types.
    • In terms of further sanitation guidance - nothing new today.  CDC reinforces and will reiterate that while environmental factors play a limited role in transmission, high touch surfaces should be cleaned often. 

Additional materials sent from CDC after the call.  Here is a packet from CDC that members and state partners can use to talk about the Delta variant.  In addition, after the call, CDC provided the following two items:

7/29/21: Morbidity and Mortality Weekly Report (MMWR): Guidance for Implementing COVID-19 Prevention Strategies in the Context of Varying Community Transmission Levels and Vaccination Coverage: Given the spread of the highly transmissible Delta variant, local decision-makers should assess the following factors to inform the need for layered prevention strategies across a range of settings: level of SARS-CoV-2 community transmission, health system capacity, vaccination coverage, capacity for early detection of increases in COVID-19 cases, and populations at risk for severe outcomes from COVID-19.

Although increasing COVID-19 vaccination coverage remains the most effective means to achieve control of the pandemic, additional layered prevention strategies will be needed in the short-term to minimize preventable morbidity and mortality. Read more here: Guidance for Implementing COVID-19 Prevention Strategies in the Context of Varying Community Transmission Levels and Vaccination Coverage | MMWR (cdc.gov)

7/29/21: CDC Health Advisory: Vaccination to Prevent COVID-19 Outbreaks with Current and Emergent Variants - United States, 2021: The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network Health Advisory to notify public health practitioners and clinicians about the urgent need to increase COVID-19 vaccination coverage (i.e., the percentage of the population fully vaccinated) across the United States to prevent surges in new infections that could increase COVID-19 related morbidity and mortality, overwhelm healthcare capacity, and widen existing COVID-19-related health disparities. Increasing vaccination coverage is especially urgent in areas where current coverage is low. Unvaccinated persons account for the majority of new COVID-19 infections, hospitalizations, and deaths. Currently circulating SARS-CoV-2 variants of concern, especially the highly infectious Delta variant (B.1.617.2), are accelerating spread of infection. Unvaccinated and partially vaccinated people need to practice all recommended prevention measures until fully vaccinated. In areas with substantial and high transmission, CDC recommends that fully vaccinated individuals wear a mask in public indoor settings to help prevent the spread of Delta and protect others. Read more here: HAN Archive - 00447 | Health Alert Network (HAN) (cdc.gov)

7/23/21: DHHS announced Wednesday that the contract has been signed with Primaris to complete all outstanding IDR's and IIDR's within the state. There are currently 46 outstanding IDR/IIDR's that need to be completed, and this company will begin reaching out to facilities that have outstanding IDR's or IIDR's beginning next Wednesday, July 28th.

7/23/21: Monday, the U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra extended the ongoing COVID-19 public health emergency (PHE) for an additional 90 days. The new expiration date for the COVID-19 PHE is now set for Monday, October 18, 2021. Currently, it is expected that HHS will continue to renew its declaration of the PHE every 90 days through the end of 2021 and will provide 60 days' notice prior to ending it.  As long as the PHE is in place, the Centers for Medicare and Medicaid Services (CMS) may retain its 1135 waivers. However, CMS could decide to phase out other waivers prior to the end of the PHE if it determines they are no longer needed. CMS will continue to monitor the emergency blanket waivers and may provide future updates.

7/23/21: CMS ruling on Access-Controlled Egress Doors: From: Hohbein, Doug <Doug.Hohbein@nebraska.gov> I have received a few calls and emails regarding a recent statement issued by the Kansas State Fire Marshal through the Kansas Health Care Association. The statement appears to reflect a major change in how fire codes for door locking are enforced.  The statement says the change comes from CMS. Here is the statement (click to download/view document). I want to let you and your members know that I spoke with the CMS Regional Office in Kansas City today, and there will be NO CHANGE in how the Nebraska State Fire Marshal's Office enforces door locking procedures. There is no change in CMS enforcement, but there may have been some miscommunication between CMS and the Kansas State Fire Marshal's Office. In Nebraska we will continue to allow delayed-egress locks, card readers, keypads and specialized locking systems such as Hugs and WanderGuard to ensure infant protection and prevent resident elopement. I want to make sure there is no confusion between the State Fire Marshal's Office and your members in regard to Life Safety Code issues of enforcement and interpretation. I hope this information helps.  Let me know if you have any questions or comments.

Thanks Doug Hohbein, CLSSEGB
Assistant State Fire Marshal  
Nebraska State Fire Marshal Agency
246 S. 14th St #1
Lincoln, NE  68508
Office: 402-471-2027
Cell:    402-326-2765
doug.hohbein@nebraska.gov

7/16/21: New guidance on masking for Assisted Living residents   DHHS issued a new guidance regarding the use of masks for Assisted Living residents that are fully vaccinated. This guidance does not apply to nursing homes as CDC/CMS have not yet updated their guidance. The new guidance was sent in an email to facilities on July 14th and can be found here:   https://www.nehca.org/wp-content/uploads/DHHS-ALF-Masking-Guidance-7-12-21.pdf
7/16/21: OSHA extends deadline for comments on Emergency Temporary Standards (ETS) until August 20th   Facilities and individuals are encouraged to submit comments regarding the OSHA ETS using this link: https://www.regulations.gov/document/OSHA-2020-0004-1033   The LeadingAge summary of the OSHA ETS can be found here: https://leadingage.org/regulation/osha-issues-temporary-emergency-standard-healthcare-settings   The link for the OSHA ETS website and the FAQ's: https://www.osha.gov/coronavirus/ets  https://www.osha.gov/coronavirus/ets/faqs   
7/16/21: Changes to LoC Determination for Aged & Disabled Waiver Applicants:  Effective July 1st, changes were implemented to the process for Level of Care determination for Medicaid eligible recipients, including those in assisted living. The determination for new A&D waivers is being transitioned to the Division of Developmental Disabilities, rather than the local Area Agency on Aging (AAA) or League of Human Dignity (LHD).

With the new process for requesting approval of Medicaid Waiver for Assisted Living, individuals must first submit a Medicaid application to DHHS and be approved prior to requesting a LoC determination. The Level of Care Determination will now be conducted through the DHHS Division of Developmental Disabilities and not the AAA or LHD. Once the request is received, a DD Division representative will conduct an in-person assessment and make a determination if the individual does or does not meet the criteria for A&D Medicaid Waiver services, within 14 days. After the determination is made the AAA or LHD will be contacted and will meet with the individual to develop a Service Plan. This process only applies to new applicants for A&D Waiver services at this time; however, all determinations will be phased in over the next 8 months... see proposed timeline below.

Currently, this is primarily applicable to Assisted Living Facilities as their process changed July 1st; however, Nursing Homes will be phased into the new process as noted below.

Proposed timeline for the transition of NF LOC:
- July 1, 2021 - all initial applications for AD Waiver
- October 1, 2021 - renewals for AD Waiver applicants ages 18-64, screening for nursing facility residents 18-64 (previously Senior Care Options, SCO) and all PACE initial referrals.
- January 1, 2022 - renewals for Nursing Facility LOC for A&D Waiver applicants for individuals 64 and over and all PACE renewals.
- March 1, 2022 - Nursing Facility Screening (previously known as SCO) for all individuals 65 and over.

Here is the contact information for AD Waiver Referrals and the link to the application: DHHS.ADWaiverApp@nebraska.gov  FAX:  402-328-6257 800#:  877-667-6266 (This number takes the information to pass on for a referral to the Eligibility & Enrollment. It is currently being answered as a Developmental Disabilities Line which will be updated in the next week to be HCBS) Paper application is located at:  https://public-dhhs.ne.gov/Forms/Home.aspx and in Search, by Form Number: DD-10 (this you must type in) Completion of Section 1 would meet the needs of a referral to the AD Waiver Any other Sections could be completed at the applicants choice. 

Meetings have been scheduled with Home and Community Based Waiver office, every other week, on Fridays from 1:00-2:00.  See the link below for those meetings. If you have questions about this process, please forward them to Deb Sutton deb.sutton@jchealthandlife.org, as Curtis & Tracy would appreciate the opportunity to see your questions in advance so they can be prepared to have answers.  

Discussion of Changes to the Level of Care Determination Process
Friday, July 23, 2021 | 1:00 p.m. CT
Join Via Zoom: https://nehca-org.zoom.us/j/85491242938 
Or Call: 312-626-6799  |  Webinar ID: 854 9124 2938 | Passcode: 2021  
Licensure Renewals Due by October 31, 2021   Nebraska DHHS News Release - July 2, 2021   June 30, 2021, marked the last day of the COVID-19 coronavirus pandemic state of emergency in Nebraska.  Executive Order 20-10 which was implemented by Governor Ricketts at the beginning of the COVID-19 State of Emergency, will expire on July 30, 2021.    Several statutes and regulations affecting certain state licenses in the Uniform Credentialing Act had been suspended or deferred during the pandemic.  Because the State of Emergency is over, those licensees impacted by the original order will be notified through a mailing that they need to renew their license before October 31, 2021.   To renew, go to dhhs.ne.gov/renew.  A wallet card can be printed to verify the new expiration date at dhhs.ne.gov/lookup.   For information regarding Continuing Competency waivers, visit http://dhhs.ne.gov/licensure/Documents/ContCompWaiverInfo.pdf