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April 21st COVID-19 Update

In recent days, several new guidance documents and requirements related to the COVID-19 emergency have been issued for providers of long-term/post-acute care (LTPAC) and senior services. These and other developments are described in detail 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 20th, is available here. In addition to updates from LeadingAge NY staff, this week’s webinar features an overview of member organization Loretto and ImagineMIC’s MonitorMe™ telehealth program from Joelle Margrey, Loretto’s vice president of skilled nursing and rehabilitation. Questions regarding MonitorMe™ and its ability to assist skilled nursing facilities (SNFs) may be directed to ImagineMIC’s Rachel McIntosh at r@imaginemic.com. If you have questions for next week’s webinar, please send them to Ami Schnauber, and be sure to check your email for the access information, or contact Jeff Diamond.

In addition, LeadingAge NY continues to 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

DOH Issues Guidance for Resident and Family Communication in ACFs and Nursing Homes

On April 20th, the Department of Health (DOH) issued Dear Administrator Letter (DAL) C20-01 containing a number of best practices and ways to keep residents and families engaged during the COVID-19 pandemic, many of which LeadingAge NY members have already adopted. The best practices offer ways of keeping residents connected and promote ways to address feelings of social isolation and loneliness that many ACF and nursing home residents may be experiencing.

Significant in the DAL is reference to the Governor’s Executive Orders (202.18 and 202.19) requiring that any SNF, nursing home, or ACF licensed and regulated by the Commissioner of Health notify family members or next of kin for all residents if any resident tests positive for COVID-19, or if any resident suffers a COVID-19-related death, within 24 hours of such positive test result or death. Financial penalties may be assessed for violations of the Executive Order.

The DAL does not address how the communication to family members should take place. Currently, communication between families and members may take place through a variety of different means, including email, website postings, or phone messages. Members should assess what system will work best for them that will allow flexibility and enable them to remain compliant with the Executive Order.

On April 19th, the Centers for Medicare and Medicaid Services (CMS) also released a preview of proposed mandated notification requirements in memorandum QSO-20-26, outlined in the Nursing Home Updates section below.

LeadingAge NY and CCLC Develop Talking Points and Fact Sheets on COVID-19 Fatality Data

LeadingAge NY and the Continuing Care Leadership Coalition (CCLC) have developed a series of talking points that nursing homes and ACFs can use in their internal and external messaging on the State’s reporting of COVID-19 fatalities in nursing homes and ACFs. Also included are fact sheets providing additional descriptive information on the residents/patients in these facilities. To access these resources, click here.

Coronavirus Financial Assistance

Last week, LeadingAge NY provided members a document that consolidates information on various grants, loans, tax benefits, and advance funding opportunities for not-for-profit providers impacted by the COVID-19 pandemic. That document has been expanded to include Housing and Urban Development (HUD) programs as well and is available here. Please note that at this time, Paycheck Protection Program and Economic Injury Disaster Loan funding has been depleted. However, we anticipate additional funding for these programs and recommend that members who are interested in participating have the requisite documentation ready so that they can apply quickly if and when additional funding becomes available. We will keep members posted of developments and update the financial assistance document as needed.

Provider Relief Funding Attestation

The Department of Health and Human Services (HHS) distributed $30 billion in provider relief funding based on provider 2019 Medicare fee-for-service (FFS) revenue. These funds were distributed primarily as direct deposits beginning as early as April 10th and continuing through last week. Providers who receive COVID-19 provider relief funds are required to agree to the terms and conditions related to the distribution by signing an online attestation within 30 days. HHS has established a portal for providers to do so here. The terms and conditions document originally posted is available here. Members may want to have their counsel review the terms prior to signing the attestation if they have any questions or concerns. Members who had FFS Medicare revenue in 2019 but have not yet received the funding can check on the status of their distribution by emailing HHS at HOSPITALCOVID19@hhs.gov or calling 866-569-3522.

DOH Issues Special Edition of Medicaid Update Regarding Online Medicaid Provider Enrollment Process

On April 20th, DOH issued a special edition of the Medicaid Update regarding the State Medicaid program’s launch of Online Medicaid Provider Enrollment during the COVID-19 emergency. The online service offers a streamlined process for those providers interested in offering Medicaid services.

CMS has allowed states temporary flexibility to enroll temporary Medicaid providers in FFS Medicaid while addressing the COVID-19 pandemic. This update details actions taken to implement and streamline this process, including the creation of a Provisional Temporary Provider Enrollment (PTPE) application process available for the duration of the public health emergency. It is currently only available to certain providers, including licensed practical nurses (LPNs), registered nurses (RNs), nurse practitioners (NPs), physicians, and registered physician assistants (RPAs).

To expedite and simplify the enrollment process, the DOH Bureau of Provider Enrollment has taken action to implement the following:

  1. Create an online PTPE application process that allows physicians, RPAs, NPs, RNs, and LPNs to enroll on a temporary basis for the purpose of assisting with COVID-19 activities;
  2. Allow a retroactive effective date no earlier than March 1, 2020 for PTPEs;
  3. Waive application fees for PTPE applications;
  4. Waive the screening requirements of site visits and fingerprint-based Criminal Background Checks for PTPEs;
  5. Allow providers who are enrolled in either Medicare or another state’s Medicaid program to enroll in New York State Medicaid as Provisional Temporary providers;
  6. Allow providers who are licensed outside of New York State to render services to Medicaid members during the public health emergency as Provisional Temporary providers;
  7. Allow credentialing offices to submit multiple provider enrollments using a spreadsheet, provided by eMedNY; and
  8. Enroll providers who are not enrolled in Medicare or another state’s Medicaid program if the requested data is provided on the PTPE application and the provider: (1) is not currently excluded from New York State Medicaid; (2) does not appear on the Office of the Inspector General (OIG) Exclusions Database; and (3) is licensed and legally authorized to practice or deliver the service for which they file claims in at least one state or territory.

All Medicaid Updates can be found here, including COVID-19 editions regarding Medicaid Coverage and Reimbursement Policy and Medicaid Telehealth Guidance.

LeadingAge NY Urges HHS to Prioritize New York Providers for COVID-19 Funding

On April 15th, LeadingAge NY sent a letter to HHS urging that the distribution of the remaining $70 billion of Public Health and Social Services Emergency Funding authorized by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) be more targeted, focusing on providers in areas particularly impacted by the COVID-19 outbreak, specifically New York’s struggling LTPAC and senior services providers.

LeadingAge NY then helped to coordinate a New York congressional delegation letter, which was sent to HHS on April 17th and reiterated the call for prioritization of New York nursing homes in future allocations of the remaining $70 billion. All but four members of the delegation signed on to the letter. Congresswoman Nydia Velázquez was the leader on the letter, and a press release from her office is available here.

We are following the distribution of future CARES Act dollars closely and will be sure to keep members informed of expected payments. Additionally, LeadingAge NY is working with LeadingAge National to ensure that future COVID-19 emergency legislation addresses the needs of senior services providers. For now, we encourage members to contact Senator Schumer, Senator Gillibrand, and their representative to thank them for their support in this important initiative.

LeadingAge NY Provides Updated Workforce Resources

Updated resources for LeadingAge NY members experiencing staffing shortages, including information about New York City’s recently launched Surge Staffing Cell, are available here.

LeadingAge NY Compiles List of Executive Orders of Interest to LTPAC and Senior Services Providers

LeadingAge NY has compiled a list, by service line, of COVID-19-related Executive Orders that may impact LTPAC and senior services providers and plans.

Nursing Home Updates

CMS Previews COVID-19 Notification Requirements

On April 19th, CMS issued memorandum QSO-20-26 advising of upcoming requirements for notification of confirmed COVID-19 among residents and staff in nursing homes. The CMS letter notes that nursing homes nationwide currently are required to report suspected or confirmed COVID-19 cases to their local or state health departments. However, this data is not reported to CMS, the Centers for Disease Control and Prevention (CDC), or the Federal Emergency Management Agency (FEMA). CMS is proposing that this information be provided to the CDC’s National Health Safety Network (NHSN) and will soon provide nursing homes with specific direction on formatting and timelines to provide the information.

In addition to requiring reporting to the CDC, CMS will be requiring that facilities notify their residents and their representatives to keep them informed of the conditions inside the facility. At a minimum, nursing homes must inform residents and their representatives within 12 hours of the occurrence of a single confirmed infection of COVID-19, or three or more residents or staff with new onset of respiratory symptoms that occur within 72 hours.

Additionally, updates to residents and their representatives must be provided weekly, or each subsequent time a confirmed infection of COVID-19 is identified and/or whenever three or more residents or staff with new onset of respiratory symptoms occurs within 72 hours. Facilities will include information on mitigating actions implemented to prevent or reduce the risk of transmission, including if normal operations in the nursing home will be altered. This information must be reported in accordance with existing privacy regulations and statute.

While no effective date is noted for the proposed requirements, LeadingAge NY expect them to be implemented shortly.

ACF Updates

DOH to Host ACF Informational Update Call on April 22nd

The DOH Division of ACF/Assisted Living Surveillance and the Bureau of Healthcare Associated Infections will host a conference call to provide informational updates specific to ACFs on Wed., April 22nd at 2 p.m. Administrators, operators, case managers, executive directors, directors of resident services, and other staff are encouraged to participate as they are able.

To join the call, please dial 1-844-512-2950. Please note that there will be no audience interaction or slide deck and that any questions should be forwarded to covidadultcareinfo@health.ny.gov.