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July 12th 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 July 11th, is available here, and a list of the items shared by LeadingAge NY staff in the webinar chat can be accessed here. If you have questions for next week’s update or would like the access information, please contact Jeff Diamond.

Cross-Sector Updates

Reporting Underway for Provider Relief Received in First Half of 2021

The third reporting period for recipients of federal COVID-19 Provider Relief Funding (PRF) has begun. Members who received PRF distributions totaling over $10,000 during the period Jan. 1, 2021 through June 30, 2021 are required to report on the use of the funds by the end of September 2022. The reporting catchment period is likely to include some Phase 3 General Distribution funding (which began in December 2020) and certainly includes infection control quality improvement program funding for November 2020 and December 2020 performance paid to nursing homes. Please note that you may use payments for eligible expenses incurred prior to receipt of those payments (i.e., pre-award costs) so long as they are to prevent, prepare for, and respond to coronavirus. Funding received during the first half of 2021 can be applied to allowable expenses incurred from Jan. 1, 2020 through June 30, 2022. Please note that due to the timing of the distributions, a number of providers may not meet the $10,000 aggregate payment threshold during this reporting period.

Nursing homes that qualified for performance-based Infection Control Quality Incentive Payments (QIP) would have received payments on or soon after Jan. 25th and/or Feb. 12th. Nursing home providers should bear in mind that the terms and conditions related to use of infection control funding are more restrictive than those governing the use of General Distribution funding. The many reporting resources developed by the Health Resources and Services Administration (HRSA) (e.g., fact sheets, manuals, archived webinars), including some specific to nursing home infection control reporting, are posted here. Reporting and auditing Frequently Asked Questions (FAQs) are posted here, and the portal itself is here. A webinar for returning reporters will be broadcast on Wed., July 13th at 3 p.m. Registration is available here. Please let us know if you have questions or have an unusual situation such as having missed a required report, discovered errors on a filed report, or needed to return funds.

Federal Public Health Emergency Extension Due July 15th

The 90-day period since the most recent extension of the COVID-19 Public Health Emergency (PHE) ends this week. Because the Administration has pledged to provide at least a 60-day notice prior to ending the emergency and no such notice has been provided, it is widely expected that the Declaration will be extended. Each extension so far has been for 90 days. Other than the specific waiver provisions that were detailed as sunsetting in QSO-22-15-NH & NLTC & LSC, other waiver provisions would presumably continue with an extension of the PHE, unless the Centers for Medicare and Medicaid Services (CMS) were to specifically discontinue them. As with termination of other COVID-19 waivers, we expect that CMS will provide advance notice that either the PHE or the specific waiver is expiring. Providers can review the CMS document named COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, most recently updated June 16th, to see which waivers remain in effect. The document includes a list of waivers in effect as well as those that have been rescinded, indicating their end dates.

The waiver of the three-day hospital stay requirement for skilled nursing facility (SNF) eligibility remains in place. While it does not require the individual to be directly impacted by COVID-19, members should be certain to document the reason for its use and ensure that they use the appropriate billing modifiers on their claims. The waiver that allows renewed coverage without a 60-day wellness period is more restrictive and only applies for those beneficiaries who have been delayed or prevented by the PHE itself from commencing or completing the 60-day “wellness period” that would have occurred under normal circumstances. Please keep in mind that the waivers apply to Medicare fee-for-service (FFS) residents; for a Medicare managed care plan enrollee, providers should check with the resident’s Advantage plan on whether the provisions are being waived. General information on billing when waivers are being used is available here, and a LeadingAge National document describing the two payment waivers is here.

CDC Issues Infection Control Guidance on Monkeypox for Health Care Settings

On the July 11th LeadingAge National COVID-19 member call, it was noted that on July 5th, the Centers for Disease Control and Prevention (CDC) issued new guidance on infection prevention and control for the Monkeypox virus. Staff stressed that SNF Infection Preventionists (IPs) should review the new guidance and ensure that their policies and procedures are in compliance.

The New York State Department of Health (DOH) also issued two Health Advisories recently, dated June 17th and July 8th, which are not specifically directed at SNFs, but provide crucial information related to Monkeypox, including, but not limited to, vaccination and testing for the virus.

LeadingAge NY will continue to coordinate with LeadingAge National on this as well as monitor the CDC website for any updates that may affect our members.

Nursing Home Updates

Community Transmission Rates Remain Volatile

Nursing homes should continue monitoring CDC Transmission Rates posted by the CDC to review their county’s rate and determine the appropriate frequency of routine staff testing for those who are not up to date with COVID-19 vaccinations. Health care providers should seek out the four-color COVID-19 Community Transmission Rates map on the CDC website (not the tri-color Community Levels map that also appears on the CDC site) to determine testing frequency. The link to the Community Transmission Rates map on the CDC site is here. Along with the most current map, the CDC site allows the user to view a map from any of the preceding 30 days by clicking on the “View a Time Lapse” button located near the top right corner of the map. LeadingAge NY also continues to post the map on a weekly basis here (please refresh your browser to ensure that you are viewing the most recent posting).

As described below, CMS indicates that nursing homes should monitor transmission rates on a regular schedule every two weeks. Day-to-day volatility, especially the updates made at the beginning of the week, can lead to frustration. For example, the number of New York State counties in yellow (i.e., with moderate transmission rates) dropped from 24 to five from Monday to Tuesday of this week.

Nursing homes should routinely test staff who are not up to date with their COVID-19 vaccinations (i.e., those 50 and over who are eligible but have not received a second booster as well as those under 50 who are eligible but have not received a first booster) at the frequency listed in CMS QSO-20-38 NH (revised March 2022). The QSO specifies that facilities should monitor their level of community transmission every other week (e.g., first and third Monday of every month) and adjust the frequency of routine staff testing based on those findings. Note that if the level of community transmission increases to a higher level of activity, the facility should begin testing staff at the higher frequency level as soon as the criteria for the higher activity level are met. However, if the level of community transmission decreases to a lower level of activity, the facility should continue testing staff at the higher frequency level until the level of community transmission has remained at the lower activity level for at least two weeks before reducing testing frequency.

Affordable Housing/Independent Living Updates

CSP Eligibility: Making the Case for Back-Up Generators in HUD-Assisted Senior Housing

LeadingAge National has released a new resource document to help housing providers prepare to take advantage of back-up generator installation reimbursement through the next round of Department of Housing and Urban Development (HUD) COVID-19 Supplemental Payments (CSPs), expected later this summer. Click here for more information.