July 13th 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 12^th, 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

HERO Act Model Plans Available Now

The model plans for the New York HERO Act are now available and can be found here. Of note is a statement from the Department of Labor (DOL) that the HERO Act does not apply to “any employee within the coverage of a temporary or permanent standard adopted by the Occupational Safety and Health Administration setting forth applicable standards regarding COVID-19 and/or airborne infectious agents and diseases.” Those providers who fall under the guidance of the OSHA Emergency Temporary Standard (ETS) should follow the OSHA guidance and do not need to adopt a HERO Act model plan or follow other HERO Act requirements. All other private employers should follow HERO Act guidance. Click here for more information.

Vaccination Update

Over the weekend, the Department of Health (DOH) issued an email to enrolled State Vaccination Program providers offering a process for individuals who are having difficulty connecting their contact information with the Excelsior Pass app. DOH will direct individuals having difficulty to their vaccination provider by giving them the provider’s primary and secondary points of contact and contact information as it was submitted on the provider’s COVID-19 Vaccination Program enrollment form.

LeadingAge NY is aware that some residents and staff are having difficulties with Excelsior Pass. This may be a way for those individuals to resolve those issues. A New York State Immunization Information System (NYSIIS)/Citywide Immunization Registry (CIR) Fact Sheet on Excelsior Pass may also be of help.

Please know that LeadingAge NY members’ issues with pharmacy partners entering erroneous information into NYSIIS or CIR is a separate issue. We continue to connect members with DOH and pharmacy partners to try to resolve those data errors.

State Continues Medicaid Reimbursement Policy for COVID-19 Vaccine Post-State PHE

This past weekend, DOH issued State Medicaid Coverage Policy and Billing Guidance for the Administration of COVID-19 Vaccines Authorized for Emergency Use carrying forth provisions allowing this practice post-state public health emergency (PHE). The guidance provides instructions for providers to bill the cost of administration of authorized COVID-19 vaccine.

As announced in Executive Order (EO) 210, the state PHE ended effective June 25^th. New York Medicaid’s policy for the administration of COVID-19 vaccine will continue to remain in effect in accordance with the federal Public Readiness and Emergency Preparedness Act (PREP Act). As additional COVID-19 vaccines become available under an emergency use authorization (EUA) or are otherwise approved by the Food and Drug Administration (FDA), the billing guidance will be updated as needed.

As members know, the many Medicaid telehealth flexibilities granted during the state PHE were also extended through the end of the federal PHE. A recent DOH Medicaid Update providing more details is available here.

First “Payment Received” Provider Relief Reporting Window Now Open

Organizations that received more than $10,000 in Coronavirus Aid, Relief, and Economic Security Act (CARES Act) Provider Relief Funding (PRF) before July 1, 2020 have between July 1^st and Sept. 30, 2021 to report on the use of funds through the dedicated reporting portal. Because the Department of Health and Human Services (HHS) continues to provide additional clarifications regarding use and reporting of the funds, LeadingAge NY recommends that members become familiar with the requirements and ensure that they have carefully considered all sources of COVID-19 relief before completing the report. Please note that we will offer educational opportunities, including during our upcoming Financial Professionals Conference. HHS will host recorded Reporting Technical Assistance Sessions on reporting requirements for PRF recipients and stakeholders at 3 p.m. on July 14^th and July 20^th. The registration links are here (July 14^th) and here (July 20^th).

The PRF webpage also offers a number of reporting resources, including:

Members who are required to report by Sept. 30^th should ensure that they have registered in the reporting portal and be certain to compile and document COVID-19-related financial impacts (expenses and lost revenue) as well as any funding received to cover such expenses. Some general information with links to the reporting portal and other resources is here, and an article from LeadingAge National on PRF reporting is available here. The HHS PRF Frequently Asked Questions (FAQ) document remains the primary resource through which the agency provides updates and clarifications related to PRF and is available here. The reporting portal FAQ document is here, and the main reporting guidance (issued June 11^th) is here.

Nursing Home and Adult Care Facility (ACF)/Assisted Living Updates

DOH Issues Revised ACF Visitation Guidance

On July 8^th, DOH issued updated guidance for ACFs regarding visitation, communal dining, and activities. The guidance continues to stress the provider’s responsibility to adhere to and ensure compliance with the core principles of infection control. LeadingAge NY encourages members to review the guidance carefully but provides a summary of the changes and clarifications here.

DOH Updates Nursing Home Visitation Guidance to Align with CMS and CDC Guidance

On July 8^th, DOH released updated nursing home visitation and social interaction guidance that aligns with Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) guidance and clarifies certain issues that have been subject to various interpretations by regional office personnel. Click here for more information.

Test Positivity and Vaccination 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 CMS-computed test positivity rates (that exclude point-of-care tests) are below 2 percent in all of New York’s counties other than Lewis and Schoharie, while the state-calculated rates (that include all tests) are below 1 percent in all but four counties. While the county positivity rates have inched upward, the increase is tied to a significant decrease in the number of tests being performed (which includes the discontinuation of most of the previously mandated twice-weekly testing of nursing home staff and weekly testing of assisted living staff). The county positivity data posted by CMS are lagged by a week and are updated each Monday or Tuesday. They are available for download in raw format here. We will continue to extract the CMS-calculated rates for New York State counties and post them here, along with positivity rates calculated on state data covering the same two-week period.

Current daily county-level data for New York State are here, 7- and 14-day regional data are here, and ZIP code-level data for New York City showing infection rates during the most recent four weeks are available here. The State’s regional COVID-19 Early Warning Monitoring Dashboard showing new infections, severity of infections, and hospitalization data is available here.

DOH posts daily COVID-19 vaccination rates for staff and residents of both nursing homes and assisted living facilities on their website. The site shows county and regional average vaccination rates and contains links to provider-specific listings. The statewide nursing home staff vaccination rate has reached 67 percent. The ACF staff vaccination rate is at 73 percent, with 94 percent of ACF residents vaccinated. The nursing home resident vaccination rate is 87 percent. The rates are based on daily Health Emergency Response Data System (HERDS) reporting and can be accessed here. The vaccination rate for the general population in New York (age 18 and over) is 73.3 percent and 89.4 percent for those between ages 65 and 74. ZIP code-level vaccination rates are available here.

NHSN Updates on Hold

As we reported to members on July 12^th, the CDC is working on updates to the National Healthcare Safety Network (NHSN) COVID-19 module that nursing homes use to report required COVID-19 data. Please note that the changes that were scheduled to be made last week are on hold. Among the intended changes is a discontinuation of the ventilator capacity pathway. However, until the changes are implemented and announced, providers should continue to report ventilator use. The other changes being implemented include an update to the reporting layout to make it more user-friendly and the addition of some pop-up alerts to help ensure data accuracy. The webinar the CDC held to preview the changes will be posted to the NHSN LTCF COVID-19 Module page, and NHSN will notify users when the changes become active. We urge members to review the resources on that page as well as on the separate Staff and Resident Vaccination reporting page to ensure that they are reporting all the required data on a weekly basis.

Home and Community-Based Services (HCBS) Updates

Applicability of OSHA ETS and New York HERO Act to Home Care Agencies

For a discussion of the requirements of the OSHA ETS and New York HERO Act as they pertain to home health providers, click here.

DOH Submits Spending Plan for Enhanced HCBS FMAP

DOH has submitted its spending recommendations for the 10 percent enhanced HCBS Federal Medical Assistance Percentage (FMAP) funding it will receive from the American Rescue Plan Act (ARPA) enacted in March 2021. Click here for a review of the key proposals.