April 7th COVID-19 Update

New guidance and requirements pertaining to the COVID-19 emergency continue to be promulgated daily by both the state and federal government. The latest updates for providers of long-term/post-acute care (LTPAC) and senior services are outlined 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 6^th, can be accessed here. Please send any questions to Ami Schnauber, and check your email for the dial-in information, or contact Jeff Diamond. Additionally, LeadingAge NY is regularly updating 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 Suspends Provider and Managed Care Plan Medicaid Enrollment Revalidation Activities

The Department of Health (DOH) has suspended all Medicaid provider and managed care plan enrollment revalidation activities for the duration of the COVID-19 emergency. This suspension is based on authority granted by the Centers for Medicare and Medicaid Services (CMS) through an 1135 waiver. Specifically, the Department has:

• Suspended all notices requesting provider revalidation;
• Suspended all notices of termination due to provider failure to revalidate;
• Suspended review of revalidation applications currently pending before the Department;
• Allowed providers who have already received revalidation notices to suspend their revalidation until further notification that the emergency is terminated and revalidation will resume; and
• Reactivated participation of non-revalidating providers terminated or scheduled for termination on or after March 1, 2020.

Upon termination of the emergency, providers will be notified of their obligation to revalidate. More information is available on the eMedNY website here.

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

On April 4^th, DOH issued guidance strongly encouraging nursing homes and ACFs to implement a communication protocol for both residents and their families, loved ones, and guardians unable to visit the resident during the COVID-19 emergency. A number of best practices to consider when creating a communication protocol are included in the guidance. The document addresses situations where there is a suspected or positive case, as well as situations where there have not been any incidents of exposure. With the current restrictions on visitation in both nursing homes and ACFs, the need for families to stay connected and informed is a priority.

List of Available Fingerprinting Sites for Criminal History Record Checks

LeadingAge NY is working to assist members in facilitating expedited criminal history record checks (CHRCs) to bring on additional staff during the COVID-19 emergency. Please see the full list of available CHRC fingerprinting sites so that you can seek alternative arrangements if your local site is closed. Sites with limited hours are listed as well.

Nursing Home Updates

CMS Issues Waiver on Paid Feeding Assistants

On April 7^th, DOH issued a Health Advisory announcing that the State has received a waiver from CMS of the eight-hour training requirement for paid feeding assistants.

As outlined in the Advisory, during the COVID-19 emergency, a facility may use a feeding assistant who has not completed the standard eight-hour training program if:

• The facility provides abbreviated training to the feeding assistant in the following areas, at minimum:
  • Feeding techniques;
  • Assistance with feeding and hydration;
  • Communication and interpersonal skills;
  • Appropriate responses to resident behavior;
  • Safety and emergency procedures, including the Heimlich maneuver;
  • Infection control;
  • Resident rights; and
  • Recognizing changes in residents that are inconsistent with their normal behavior and the importance of reporting those changes to the supervisory nurse.
• The feeding assistant successfully completes a competency assessment upon completion of the training; and
• The feeding assistant provides dining assistance only for residents who have no complicated feeding problems. Complicated feeding problems include, but are not limited to, difficulty swallowing, recurrent lung aspirations, and tube or parenteral/IV feedings. The facility must base resident selection on the interdisciplinary team’s assessment and the resident’s latest assessment and plan of care. Appropriateness for this program should be reflected in the comprehensive care plan.

Additionally, the feeding assistant must work under the supervision of a registered nurse (RN) or licensed practical nurse (LPN).

CMS Releases 1135 Waivers

On April 4^th, DOH released a Health Advisory outlining a number of 1135 waivers recently issued by CMS. The document addresses several questions raised by members regarding the hiring of staff during the COVID-19 crisis.

As noted in the Advisory:

To ensure resident health and safety, requirements at 42 CFR §483.35(d) are waived except 42 CFR §483.35(d)(1)(i), which requires that a Skilled Nursing Facility (SNF) and Nursing Facility (NF) may not employ anyone for longer than four months unless they meet the training and certification requirements under §483.35(d).

CMS is not waiving §483.35(c), which requires facilities to ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care.

The Advisory recommends consideration of the following:

• Hiring nursing students, personal care assistants, and home health aides, and developing a competency skills evaluation tool for staff with prior health care experience to work as a nurse aide;
• Hiring staff without prior health care experience, but who are otherwise competent to provide nursing-related services, to work as a nurse aide, and developing a training program with a competency skills evaluation tool for staff without prior health care experience;
• Maintaining a record of the completed competency evaluation tool in the employee’s personnel file; and
• Rehiring certified nursing assistants (CNAs) who have retired or those whose retraining requirements have lapsed.

The waiver thus allows for the hiring of individuals who have completed the CNA training program but have yet to take the exam, as well as those individuals whose certification is expiring. Both of these situations have arisen as a result of the closure of Prometric testing.

There are several other waivers noted in the Advisory, including:

• Preadmission Screening and Resident Review (PASRR): Allowing states and nursing homes to suspend these assessments for new residents for 30 days. After 30 days, new patients admitted to nursing homes with a mental illness or intellectual disability should receive the assessment, as soon as resources become available.
• Resident Groups: CMS is waiving the requirements at 42 CFR §483.10(f)(5) which ensure that residents can participate in person in resident groups. This waiver would only permit the facility to restrict in-person meetings during the national emergency given the recommendations of social distancing and limiting gatherings of more than 10 people.
• Physician Visits in SNFs/NFs: CMS is waiving the requirement at 42 CFR §483.30 for physicians and non-physician practitioners to perform in-person visits for nursing home residents to allow visits to be conducted, as appropriate, via telehealth options.

CMS Issues New COVID-19 Recommendations

On April 2^nd, CMS issued enhanced recommendations for nursing homes that draw on Centers for Disease Control and Prevention (CDC) guidance and should be implemented immediately. The CMS guidance directs nursing homes to refer to the previously issued QSO-20-20 document containing a focused survey infection control tool. Additionally, it speaks to the importance of screening for all individuals living or working in the nursing home and encourages the limitation of access points to ensure that all individuals, with the exception of emergency medical services (EMS) personnel, will be screened. The guidance also addresses the use and types of masks, recommending that all personnel wear a mask while in the facility and that facilities cohort staff to prevent the risk of transmission.

Adult Care Facility Updates

DOH Issues Guidance on Hospital Admissions and Discharges to ACFs

On April 7^th, DOH issued new guidance for ACFs regarding hospital admissions and discharges. The guidance calls for all ACFs to have a process in place to expedite return of asymptomatic residents from the hospital. Residents are deemed appropriate for return to an ACF upon a determination, by the hospital physician or designee, that the resident is medically stable for return, in consultation with the ACF.

The guidance states that no resident shall be denied readmission or admission to the ACF solely based on a confirmed or suspected diagnosis of COVID-19. Any denial of admission or readmission must be based on the ACF’s inability to provide the level of care required by the prospective resident, pursuant to the hospital’s discharge instructions and based on the ACF’s current licensure or certification. Additionally, ACFs are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission. However, in accordance with state regulations 18 NYCRR §487.4(c)(12) and §488.4(c)(12), ACFs cannot admit residents who are symptomatic, unless the ACF’s licensure and certification require onsite clinical staff capable of attending to the medical needs of a symptomatic COVID-19 resident, pursuant to the hospital’s discharge instructions (i.e., an Enhanced Assisted Living Residence (EALR)).

HCBS Updates

DOH Releases FAQs on Non-Emergency Medical Transportation During COVID-19 Emergency

On April 7^th, DOH issued a Frequently Asked Questions (FAQ) document for non-emergency medical transportation (NEMT) providers pertaining to its March 21^st COVID-19 Guidance for Transportation Managers and Brokers. The document addresses safety, screening, and testing for front line workers; guidance for transportation drivers who test positive; guidance for managing and transporting riders, including exceptions; transporting COVID-19-positive individuals; and specific considerations regarding transport in New York City.