Dec. 29th COVID-19 Update
New COVID-19-related updates for providers of long-term/post-acute care (LTPAC) and senior services continue to be shared on a regular basis by both state and federal authorities. The latest developments are described 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. 28th, 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
New DOH Guidance Eliminates Furlough Exemptions for Exposed Staff
On Dec. 27th, the Department of Health (DOH) released new “return to work” guidance for all health care personnel that expands work exclusion requirements for asymptomatic staff who have been exposed to COVID-19. The guidance eliminates exemptions from furlough for such individuals that were authorized in prior guidance based on staffing shortages. It also increases the duration of furloughs for staff in Enhanced Assisted Living Residences (EALRs) and Assisted Living Programs (ALPs). Click here for more information.
State Vaccination Prioritization Process
New York State is currently in the process of determining which health care providers are next in line to receive the COVID-19 vaccine. This process is progressing each week as more allocations of the vaccine are distributed from the federal government to states. Click here for the latest information.
Vaccine and TB Testing Concerns
Members reported last week that some of the pharmacies participating in the federal Pharmacy Partnership for Long Term Care vaccine program were considering tuberculosis (TB) testing within 30 days of receiving the COVID-19 vaccine to be a contraindication, thus causing exclusion of those individuals from being vaccinated.
After outreach to the DOH Bureau of Immunization and their outreach to the Centers for Disease Control and Prevention (CDC), the CDC has concluded that “there is no immunologic reason that a TST would impact effectiveness of COVID-19 vaccines, including mRNA vaccines.” This follows the general principles regarding vaccination outlined in the CDC’s General Recommendations on Immunization.
The CDC has communicated to DOH that they have been in contact with CVS and Walgreens about the TB test screening question on their COVID-19 screen, and CVS and Walgreens indicated that they would be removing it from their screening form/criteria.
Members should let us know if there are any further concerns with this issue as vaccination clinics are carried out.
PPP2 and Medicare Sequestration
The federal appropriations and COVID-19 relief legislation signed into law on Dec. 27th (the Consolidated Appropriations Act, 2021) suspends Medicare sequestration for an additional three months and provides $284 million for another round of potentially forgivable Paycheck Protection Program (PPP2) loans. The regulations for PPP2 are under development, but loans are expected to be available to nonprofit organizations with 300 or fewer employees that can demonstrate a revenue decline of at least 25 percent from a given quarter in 2019 to the same quarter in 2020. Those who received a PPP loan are eligible if they meet the established criteria. We will provide additional information as it becomes available and are working to develop an educational session for members. Sequestration had been scheduled to resume Jan. 1, 2021, but the three-month extension of the suspension means that Medicare payments for services provided through March 31, 2021 will not be subject to the 2 percent sequestration reduction. A high-level overview of the legislation from LeadingAge National is available here, with information about provider relief provisions included in the bill provided here.
Nursing Home and Adult Care Facility (ACF)/Assisted Living Updates
Local Positivity Rates
A document showing the most recent 14-day test positivity rates for each county in New York State based on both federal and state figures is available here. The rates based on federal figures exceed 10 percent in 15 counties for the 14-day period ending Dec. 23rd.
Under the federal Centers for Medicare and Medicaid Services (CMS) nursing home testing guidance, when a county reaches a test positivity rate in excess of 10 percent and is designated a red zone by CMS, nursing homes must test staff twice weekly. However, CMS Frequently Asked Questions (FAQs) allow facilities to use state positivity data, instead of the federal data, to determine whether the twice-weekly testing requirement has been triggered, provided that the state data are available at the same frequency and use a similar methodology to the CDC. New York State uses a similar, but not identical, positivity rate calculation methodology to the CDC. It includes antigen test results in its data, so the denominator is greater and positivity rates are lower. Please note that for Genesee County, the positivity rate for the 14-day period ending Dec. 23rd exceeds 10 percent based on both CMS and DOH data.
Providers who opt to use the New York State rates should document the source, date, and rate used to determine the frequency of staff testing based on CMS guidance. You should also continue to use the same source for determining testing (i.e., do not switch sources from week to week). LeadingAge NY posts a weekly file showing the CMS-calculated county positivity rates along with positivity rates calculated using DOH data for the same time period as used in the CMS calculation. If the positivity rate in your county reaches a level in excess of 10 percent (based on the data source you selected), the twice-weekly CMS staff testing requirement is effective “as soon as the criteria for the higher activity are met.” It continues until the county positivity rate has remained at the lower activity level for at least two weeks.
Under the state micro-cluster guidance, nursing homes are also required to test twice weekly if the facility is in a red, orange, or yellow micro-cluster zone, even if the federal requirement is not triggered. Unlike the CMS zones, the micro-cluster zones are not county-wide – they may be ZIP codes or census tracts. Notably, if you are not required by state micro-cluster guidance to test staff twice weekly (i.e., your facility is not in a micro-cluster zone), but you are in a federal red zone, you do not need to test staff who have previously tested positive in the last 90 days twice weekly. These recovered staff do not need to be tested under the federal guidance but must continue to be tested once weekly under the state guidance.
Current daily county-level data for New York State are here, and ZIP code-level data for New York City 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 links to cluster maps and the address look-up tool are here.
Weekly Staffing Survey Due Dec. 30th at 5 P.M. Due to Holiday
DOH reminds ACFs and nursing homes that the weekly staff testing survey will open today, Dec. 29th, and close on Wed., Dec. 30th at 5 p.m. No extensions to that deadline can be granted. Please note that if you submit your survey and do not receive a confirmation email, the system did not log your submission. Members are advised to print their submission for their records. Providers have been getting violations for failure to submit the report on time.
HERDS and Weekly Staffing Survey Deficiencies
LeadingAge NY has heard from some members that they are receiving deficiencies for failing to submit a Health Emergency Response Data System (HERDS) survey or weekly staffing survey on time when they have, in fact, submitted on time. If you have experienced this, please contact Diane Darbyshire or Karen Lipson, as we are providing information to DOH to try and sort out why some facilities are getting erroneous notices and resolve the issue.
ACF Vaccination Update
DOH has shared that some ACFs in the state have vaccination clinics scheduled. Thus, we advise that ACFs be on alert for outreach from their pharmacy partners to begin that process in the near future. We have posed some questions to the Department regarding the process; in the meantime, the Department recommends the following:
As a measure of best practice, while the pharmacists administering the vaccine are trained in CPR, it is wise to alert the ACF’s community EMS partner/s of the clinic date/s.
In addition, CDC has made the following “toolkit” available: https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/index.html.
Members are encouraged to let us know when they have their clinic scheduled and any questions or concerns they might have.
Affordable Housing/Independent Living Updates
COVID Rent Relief Program Reopens with Expanded Eligibility Criteria
New York State Homes and Community Renewal (HCR) has announced that the COVID Rent Relief Program has reopened for applications with expanded eligibility criteria. The application period will remain open through Feb. 1, 2021, and previous applicants do not need to reapply to be considered. HCR will reevaluate all applications that were denied according to the new criteria and issue revised determination letters to applicants. Click here for more information.
Governor Signs COVID-19 Emergency Eviction and Foreclosure Prevention Act of 2020
On Dec. 28th, the Legislature held a special session to approve the COVID-19 Emergency Eviction and Foreclosure Prevention Act of 2020 (A.11181/S.9114). The Act was then signed into law by Governor Cuomo. The Act goes further than the current Executive Order (EO) in protecting residential tenants from eviction and also includes protections for foreclosure proceedings, credit discrimination, and negative credit reporting related to the COVID-19 emergency. The eviction provisions of the bill apply to housing providers and ACFs as long as the tenant meets the hardship requirements and does not meet the grounds for an exemption. Click here for more information.
Deadline Approaches for Service Coordinator CARES Act Spending
As grant-funded Service Coordination programs receive initial approval from the Department of Housing and Urban Development (HUD) for Coronavirus Aid, Relief, and Economic Security Act (CARES Act) payments, HUD-assisted housing providers need to complete spending before the end of the calendar year. Click here for more information from LeadingAge National.