April 14th COVID-19 Update

In recent days, public health authorities and government regulators have issued new COVID-19-related guidance and requirements for providers of long-term/post-acute care (LTPAC) and senior services. These and other updates are delineated 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 April 13^th, is available here. Please send any questions to Ami Schnauber, and check your email for the dial-in information, or contact Jeff Diamond. In addition, LeadingAge NY continues to regularly update its questions and answers (Q&As) for members on operational and regulatory issues related to COVID-19. The Q&As include information on numerous cross-sector issues, as well as issues specific to nursing homes, adult care facilities (ACFs)/assisted living, adult day health care (ADHC), home and community-based services (HCBS), and affordable housing/independent living. To access the Q&As, click here.

Cross-Sector Updates

Index of Coronavirus Funding Opportunities

LeadingAge NY has consolidated information on various grants, loans, tax benefits, and advance funding opportunities into a single document, available here. Along with a brief description of each program, the document provides links to further information. We will update it as additional opportunities become available.

HHS Distributes Provider Relief Funding

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) dedicates $100 billion to hospitals and other providers to support health care-related expenses, assist with lost revenue attributable to COVID-19, and ensure that uninsured Americans can get testing and treatment. The Department of Health and Human Services (HHS) began distributing $30 billion of this funding on Fri., April 10^th.

Providers receiving Medicare Part A or B fee-for-service (FFS) payments in 2019 should automatically receive the funding as an electronic transfer into their account. The funds should appear in a provider’s bank account via Optum Bank and should be identified as HHSPAYMENT or HHS STIMULUS in the payment description. Providers that receive a paper Medicare check will be issued a paper check for this funding as well. To estimate the expected payment, providers should divide their 2019 Medicare FFS revenue by $484 billion and multiply the quotient by $30 billion.

This distribution is a grant, not a loan, and requires no application. However, recipients will be required to agree to terms and conditions within 30 days of receiving funds. The portal for signing the attestation is not yet available, but HHS indicates that it will be opened the week of April 13^th and be linked from the CARES Act Provider Relief Fund page. We will let members know when it becomes available.

FEMA-Approved Non-Congregate Sheltering Plan

On April 13^th, the Department of Health (DOH) notified providers of New York’s statewide Non-Congregate Sheltering Plan, which identifies three target populations for non-congregate sheltering:

• COVID-19-positive individuals requiring isolation but not hospitalization and who:
  • Do not have an appropriate home setting, or
  • Have a medically vulnerable individual in the home setting where they would otherwise be isolated
• Health care providers and emergency responders interacting with presumptive or confirmed positive COVID-19 patients in an occupational setting, to include testing sites;
• Individuals that are or were supported by a congregate care shelter facility, to include:
  • Homeless persons
  • Domestic violence survivors
  • Elder abuse survivors

This approval allows governmental entities and private non-profits to utilize hotel and motel rooms as non-congregate sheltering for certain defined populations. The costs associated with non-congregate sheltering conforming to New York's approved plan would be eligible for partial reimbursement under the Federal Emergency Management Agency’s (FEMA) Public Assistance program. A slide deck outlining the State's non-congregate sheltering plan and FEMA’s requirements for applicants to implement that plan is linked here.

PACE/MLTC Updates

CMS Issues PACE Q&As and Risk Adjustment Submission Guidance for Medicare Advantage and PACE Organizations

The Centers for Medicare and Medicaid Services (CMS) released COVID-19-related Q&As for Program of All-Inclusive Care for the Elderly (PACE) organizations on April 14^th. The Q&As cover a variety of issues, including clinical concerns, enrollment and disenrollment, telehealth, quality and reporting, and billing and payment. In addition, CMS published risk adjustment submission guidance that authorizes PACE and Medicare Advantage organizations to use telehealth visits to provide the diagnoses that support risk adjustment submissions.

The following are noteworthy elements of the PACE Q&As:

• PACE participants with symptoms that may be attributable to COVID-19 should not attend the PACE center in order to mitigate the risk of infecting other participants and/or personnel. Rapid transmission can occur in communal settings and should be avoided.
• If possible, the PACE organization should consider arranging for home-based evaluations for mildly symptomatic residents to reduce potential exposure of others to a person who might end up COVID-19-positive.
• CMS recommends active screening of PACE participants and staff for fever and respiratory symptoms.
• In order to qualify for the enhanced federal Medicaid match, states must provide continuous Medicaid coverage, through the end of the month in which the emergency period ends, to all Medicaid beneficiaries who were enrolled in Medicaid on or after March 18, 2020, regardless of any changes in circumstances or redeterminations at scheduled renewals that otherwise would result in termination.
• CMS is relaxing requirements related to in-home and in-person assessment activities, provided that they are conducted via real-time audio and video telehealth modalities via a qualifying platform.
• CMS is relaxing requirements for in-person and in-center services, provided that they are conducted via real-time audio and video modalities via a qualifying platform.

The risk adjustment submission guidance seeks to further support the use of telehealth as a means of supporting access to health care, while containing community transmission. It authorizes PACE and Medicare Advantage organizations to submit diagnoses for risk adjustment purposes that are from telehealth visits, when those visits meet all criteria for risk adjustment eligibility. These criteria include being from an allowable inpatient, outpatient, or professional service and from a face-to-face encounter.

HCBS Updates

New Guidance

DOH released several HCBS-related guidance documents this past week:

• Guidance Regarding Regulatory Relief for Home Care Providers: This guidance lists many of the relief provisions already put in place by the State via Executive Order and other DOH guidance, some of which include the waiving of various HR requirements for employees, flexibility regarding submission of data in the Home Care Worker Registry, authorization of telehealth for home care agencies for supervision of aides and admissions, and flexibility of requirements for home care aide training programs. The document also includes the various waiver provisions provided by CMS for home care agencies and hospices. These include Outcome and Assessment Information Set (OASIS) flexibility regarding timing of assessments and their submission; the waiver of two-week on-site visits and supervision of aides, though telehealth is encouraged; authorization of telehealth for initial assessments and homebound status; the waiver of hospice use of volunteers, requirement to provide non-core hospice services, and on-site supervision of aides every two weeks; and flexibility in updating hospice comprehensive assessments.
• Guidance Regarding Social Adult Day Care Programs: This guidance authorizes programs to work with Managed Long Term Care (MLTC) plans to provide socialization and monitoring/well-being checks via telehealth/telephony. It prohibits programs from providing transportation and meal delivery.
• Guidance Regarding Home Health Aide Training Programs: This guidance waives the requirement that eight hours of the 16-hour supervised practical training portion of a home health aide training program be provided in a patient care setting.
• Guidance for 1915(c) Children’s Waiver HCBS Regarding Respite Services
• Updated Guidance for the Authorization of Community-Based Long-Term Services and Supports Covered by Medicaid: DOH has made clarifications to its guidance regarding initial authorizations and requests for changes in service regarding personal care, Consumer Directed Personal Assistance Services (CDPAS), and other community-based long-term services and supports (LTSS). A full Community Health Assessment (CHA) must be completed to enroll a member in MLTC. A partially completed CHA, done via telehealth (minus the functional assessment), will be referred to the local department of social services (LDSS) to develop and monitor the Plan of Care. Such Temporary Plan of Care will be allowed for 90 days. If a final one cannot be completed within that time, another 90-day cycle will be authorized until the time one can be completed. Reassessments and home visits required under Medicaid managed care, MLTC, and FFS Medicaid are suspended until further notice. Personal Assistant assessments under the Consumer Directed Personal Assistance Program (CDPAP) are suspended as well.
• UAS-NY Communication: DOH issued a notification to all providers regarding the manner in which they should be conducting the CHA in the Uniform Assessment System for New York (UAS-NY). A link to the information can be found in the UAS-NY Training Environment Course 0001-LTC Assessment Processing during the Novel COVID Period. It is the first course listed under the Recommended Courses sub-heading (as a reminder, recommended courses are never marked as “Completed”).

LHCSA Survey

DOH has now included licensed home care services agencies (LHCSAs) on the roster of providers being surveyed during the COVID-19 State of Emergency. The survey is being carried out by DOH in conjunction with IBM and Salesforce on a private platform. It seeks data regarding caseload by level of care, prior and current cases and staffing levels, on-hand and needed personal protective equipment (PPE), and confirmed and suspected staff and cases with COVID-19.