Dec. 8th COVID-19 Update
New updates pertaining to the COVID-19 emergency continue to be announced by both the state and federal government on a regular basis. The latest developments for providers of long-term/post-acute care (LTPAC) and senior services are reviewed below.
As a reminder, LeadingAge NY continues to convene weekly webinars on Mondays at 11 a.m. to address emerging questions on COVID-19. A recording of our most recent webinar, held on Dec. 7th, is available here. If you have questions for next week’s update, please send them to Ami Schnauber, and be sure to check your email for the access information, or contact Jeff Diamond.
Cross-Sector Updates
Update on Federal and State COVID-19 Vaccine Programs
At this time, most long term care facilities have signed up for the federal COVID-19 vaccination program (the Centers for Disease Control and Prevention’s (CDC) Pharmacy Partnership for Long-Term Care Program) and the New York State Vaccination Program or the New York City (NYC) Vaccination Program. In October, facilities outside of NYC were encouraged to sign up for the State program, and those in NYC were encouraged to enroll in the NYC program, which will be an implementation of the federal program. All facilities should be enrolled in programs at this time. Facilities that are not currently enrolled in the federal program and would like to be enrolled should contact LeadingAge NY immediately, and we will try to work with the Department of Health (DOH) to get you signed up. Click here for more information.
Staffing, PPE, and Technical Assistance Resources for NYC Members
NYC members are reminded of NYC-specific resources, including enrolling in the surge staffing group purchasing organization (GPO), accessing the NYC Personal Protective Equipment (PPE) Stockpile, and registering for the Surge Staffing Technical Assistance Program for nursing homes. Click here for more information.
PPE Access Update for NYC
The NYC Department of Health and Mental Hygiene (DOHMH) has removed the requirement that health care providers serving NYC have less than one week's worth of PPE in order to request PPE from the City's stockpile managed by Medline. The PPE requested is still to be used for emergency purposes in delivering care during the COVID-19 emergency.
Members should note that NYC may seek to recover costs if they are unable to be reimbursed by the Federal Emergency Management Agency (FEMA). FEMA does allow for reimbursement of supplies provided to not-for-profit entities. Members are encouraged to establish an account to prepare for shortages by contacting PPEsupport@health.nyc.gov.
Fit Testing Resources for N95 Respirators
Whenever the use of a respirator, such as an N95 respirator, is required, employers must implement a written, worksite-specific respiratory protection program (RPP) as specified in the Occupational Safety and Health Administration’s (OSHA) Respiratory Protection Standard (29 CFR 1910.134). The RPP must include medical evaluation, fit testing, training, and other elements, and the employer must be able to demonstrate that the program is enforced and updated as necessary.
A fit test is required before a respirator can be worn, yearly, and after any physical changes that may affect the fit. A successful fit test only qualifies an employee to use the specific brand/make/model and size of respirator that they wore during that test, and respirator sizing is not standardized across models or brands. For example, a medium in one model may fit differently that another manufacturer’s medium model. (A list of N95 respirators approved by the National Institute of Occupational Safety and Health (NIOSH) is available here.)
DOH operates an Occupational Health Clinic Network that has nine sites throughout the state. These clinics have providers who may be hired to do fit testing for your facility, and their contact information is available here.
You may also perform your own fit testing if you follow the OSHA Fit Testing Procedures (Appendix A to 29 CFR 1910.134). If you perform your own fit testing, you must document compliance with the OSHA Fit Testing Procedures.
State Seeks Feedback on Telehealth Use
DOH is conducting a survey of all health care providers to gain knowledge of providers’ experiences using telehealth during the COVID-19 emergency. The Department will use the results of this survey to inform post-pandemic telehealth policy development. Click here for more information.
Nursing Home and Adult Care Facility (ACF)/Assisted Living (AL) Updates
October Nursing Home Infection Control QIP Distribution
The Department of Health and Human Services (HHS) has announced that Coronavirus Aid, Relief, and Economic Security Act (CARES Act) Provider Relief Fund Nursing Home Infection Control Quality Incentive Program (QIP) payments for the October measurement period will be made starting Dec. 9th. HHS will distribute a total of $523 million, up from the $331 million distributed for September. The encouraging news is that in New York State, a total of $19.1 million (nearly twice the September allocation of $10.1 million) will be distributed to 410 homes. That means that most nursing homes in the state were able to keep their infection rate lower than that of their county and suggests that at least some of the awards will be more material than the previous month’s distribution.
Nursing Home NHSN Training
We remind nursing home members that they should continue to make every effort to ensure that their National Healthcare Safety Network (NHSN) reporting is complete and accurate. While the CDC provided early training for the fairly major reporting changes recently made to how positive residents are categorized in the NHSN COVID-19 Long Term Care Module, not all providers were able to participate. Three additional sessions have been added: Dec. 10th at 1:30 p.m., Dec. 14th at 12:30 p.m., and Dec. 17th at 1:30 p.m. All three sessions last an hour and have identical content, so please plan to attend only one. Registration for all three is available here.
Local Positivity Rates
The most recent listing of 14-day testing positivity rates for each county in New York State from the Centers for Medicare and Medicaid Services (CMS) is available here. Allegany County continues to be the only county above the 10 percent CMS threshold, although CMS-reported rates were above 5 percent in 32 New York counties for the 14-day period ending Dec. 2nd. Current daily county-level data for New York State are here, and ZIP code-level data for NYC showing infection rates during the most recent four weeks are available here. Metrics related to the State’s micro-cluster initiative are available here, and an address look-up tool is here.
One Last Opportunity to Receive Free ECHO Training and a $6,000 Facility Stipend
The New York Academy of Medicine (NYAM) and LeadingAge NY are providing member nursing homes with one last opportunity to sign up for a 16-session training sequence through Project ECHO to help keep COVID-19 from spreading in facilities and prepare and equip staff to protect residents and themselves. This training is free for two or more of your staff members and offers participating facilities a $6,000 stipend upon completion. Participation in the NYAM/LeadingAge NY training initiative is limited to the first 35 nursing homes that sign up, and the initial deadline to sign up is this Fri., Dec. 11th. Click here for more information.
Nursing Home PPE Deficiency Letters Raise Concerns
Many nursing homes received notices on Dec. 2nd indicating that their facility was out of compliance with the regulation requiring a sufficient PPE inventory to meet the needs of facility personnel. The notice was not customized to individual facilities and did not specify the items that had fallen below required levels or the extent of the shortfall. It provided affected facilities with seven days to come into compliance and threatened penalties of up to $10,000 per day for inadequate supplies and additional penalties for false certifications.
LeadingAge NY and other associations participated in a call with DOH and Governor’s Office staff to learn more about the deficiency determination process and the process for coming into compliance. Click here for more information.
Requesting Antigen Tests to Meet Holiday Guidance Requirement
DOH guidance entitled Further Information Regarding Holiday Guidance, dated Nov. 25th, provided an email to request antigen tests for ACFs and nursing homes that need them to meet the holiday guidance requirement: Covid19rapidtest@health.ny.gov. The Department stressed that this is intended only for that purpose. When requesting, it is advised that you provide your Limited Services Laboratory (LSL) registration number. Facilities using other antigen tests should be aware that only BinaxNOW supplies are available to send to facilities at this time.
On a recent call with DOH, LeadingAge NY noted that several providers did not receive any rapid tests from the federal government and asked that the State provide tests to those facilities. Discussion about the need for tests for ongoing staff testing was also raised given the ongoing and growing costs of that requirement. The Department said that they would take that back to leadership for discussion.
Orders for COVID-19 Testing of ACF Residents
On a call with DOH last week, representatives from Wadsworth Labs clarified that orders are required for COVID-19 testing of ACF residents. The Department is unwilling to provide any waiver of that requirement; however, it was noted that whoever is acting as the facility’s LSL director can provide orders for this purpose. The orders must be resident-specific, as opposed to a blanket order for all residents.
COVID-Positive ACF Staff Person Must Present Negative Test Before Returning to Work
DOH has confirmed that they are taking the position that a staff person of an ACF who tests positive for COVID-19 must present a negative test before returning to work. While this requirement is not outlined in the Revised Protocols for Personnel in Healthcare and Other Direct Care Settings to Return to Work Following COVID-19 Exposure or Infection guidance dated July 24th, DOH is taking both this and the Executive Order 202.30 – Nursing Home and ACF Staff Testing Requirement Frequently Asked Questions (FAQ) guidance issued on June 24th together to arrive at this conclusion. Notably, they reference the below questions and answers (Q&As):
6. Do staff who are on vacation need to be tested twice per week?
No. Staff who are on vacation do not need to be tested during the time period when they are on leave or otherwise not present in the same building as residents, provided that they are promptly tested upon their return to the facility. UPDATE: In light of the Travel Advisory for High Transmission States, a staff member who has traveled to a state currently listed on Department of Health list, must be tested upon return and, must not report to work until a negative result for COVID-19 is received. Such individual may return to work upon receipt of such negative test result and resume testing at the regular interval for such facility.
9. If a staff member has a positive test, should the individual be re-tested at the end of the furlough before returning to work?
Staff must test negative before returning to work. However, as stated above, this policy may be reconsidered for previously COVID-19 positive individuals as more is learned about immunity following COVID-19.
Affordable Housing/Independent Living Updates
HUD Postpones 10-Year Project Capital Needs Assessments
On Dec. 4th, the Department of Housing and Urban Development (HUD) published a memo with supplemental guidance for 10-year Project Capital Needs Assessments (PCNAs). Due to the COVID-19 emergency, HUD had previously allowed the postponement of regular 10-year PCNA updates until Sept. 30, 2020. Because of continued difficulty conducting in-person CNAs, and to allow additional time to schedule, conduct, and submit PCNA reports, HUD will extend the postponement of its regular 10-year PCNA to March 31, 2021 for properties with PCNA reports that are due between March 15, 2020 and March 31, 2021.
Any questions regarding the memo should be directed to HUD’s Michael Bruggman at 202-402-5619 or Michael.Bruggman@hud.gov.