July 20th COVID-19 Update

New updates pertaining to the COVID-19 emergency continue to be announced by both the state and federal government on a regular basis. The latest developments for providers of long-term/post-acute care (LTPAC) and senior services are reviewed 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 19^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

Federal Public Health Emergency Extended

On July 19^th, Department of Health and Human Services (HHS) Secretary Xavier Becerra renewed the federal public health emergency declaration for an additional 90 days, effective July 20^th. Although the Biden administration told governors early in the year that it expects that the emergency will remain in place until the end of 2021 and that 60 days advance notice would be provided if the decision were made to end it sooner, continuation of the emergency requires a formal renewal every 90 days. Unless specifically rescinded by the Centers for Medicare and Medicaid Services (CMS), flexibilities related to blanket 1135 and other federal waivers, including the 3-day hospital stay and authorization for temporary nurse aides, will continue until the expiration of the federal health emergency. The renewal document is 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 HHS continues to provide additional clarifications regarding use and reporting of the funds, we recommend that members become familiar with the requirements and ensure that they have carefully considered all sources of COVID-19 relief before completing the report. LeadingAge National is offering a session presented by CliftonLarsonAllen (CLA) on reporting requirements on July 22^nd at 11 a.m. Registration is available here. CLA will also present on PRF reporting during LeadingAge NY’s upcoming Financial Professionals Conference.

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 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.

FDA Announces Revisions to EUA Fact Sheets for Janssen/Johnson & Johnson Vaccine

On July 13^th, the Food and Drug Administration (FDA) announced an update to the Emergency Use Authorization (EUA) for the Janssen/Johnson & Johnson COVID-19 vaccine to include information regarding an observed increased risk of Guillain-Barré syndrome (GBS) after administration of the vaccine. Click here for more information.

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

LeadingAge NY Discusses Visitation, Workforce, and More with Key Senators

LeadingAge NY and other stakeholders met with key members of the Senate last week and provided them with an update on the current Department of Health (DOH) and federal visitation and infection control guidance for ACFs and nursing homes. The senators have heard from constituents who are concerned that they do not have as much access to their loved ones as they did pre-pandemic. LeadingAge NY conveyed that our members had consistently advocated for more access throughout the pandemic, and while things have loosened up considerably, the current infection control requirements can still result in some limitations in visitation.

LeadingAge NY also stressed to the senators the serious workforce and financial struggles that members are having across the continuum, statewide. At their request, we are compiling a list of requirements currently in place that pull staff away from other critical activities such as caring for residents and supporting quality of life activities such as visitation. We are also identifying some actions that could be taken to otherwise help with workforce shortages. LeadingAge NY will also be providing testimony to the Legislature on ACF, nursing home, and home care workforce issues on July 27^th.

LeadingAge NY stressed to the senators that providers are struggling financially due to COVID-19 and that New York was the only state to institute a Medicaid cut to providers during the pandemic. Many other states provided increased funding to their providers during this difficult time. The senators were urged to consider how to get relief to the provider community and develop strategies for workforce development in the months that lead up to the development of the 2022-23 State Budget and the next legislative session.

LeadingAge NY will continue to advocate with policymakers regarding these critical issues.

Further Guidance on OSHA ETS Applicability to ACFs Forthcoming

Upon further review, LeadingAge NY’s legal counsel, Hinman Straub, does not believe that the Occupational Safety and Health Administration (OSHA) COVID-19 Emergency Temporary Standard (ETS) applies to New York-licensed ACFs. The OSHA ETS does, however, apply to Enhanced Assisted Living Residences (EALRs) and Assisted Living Programs (ALPs) because of their utilization of licensed professionals. Hinman Straub is preparing an FAQ document to address questions on the applicability of the OSHA ETS to ACFs, home care, and Consumer Directed Personal Assistance Services (CDPAS). Once this document is available, we will circulate it to members.

In settings where the OSHA ETS does not apply, providers must follow the New York HERO Act. More information on the HERO Act and its requirements is available here, and more information on the OSHA ETS is here.

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 Richmond and Schoharie, while the state-calculated rates (that include all tests) are below 1 percent in all but five counties. While the county positivity rates have inched upward, the increase is tied to a significant decrease in the number of tests being performed. 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 is 67 percent. The ACF staff vaccination rate increased to 74 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 73.9 percent and 89.8 percent for those between ages 65 and 74. ZIP code-level vaccination rates are available here.

CDC Posts Training for NHSN Updates

Although delayed from the original July 8^th intended start date, the Centers for Disease Control and Prevention (CDC) is making updates to the National Healthcare Safety Network (NHSN) COVID-19 module that nursing homes use to report required COVID-19 data. The slides from the CDC webinar outlining the changes are now posted on the LTCF COVID-19 Module webpage here in the Archived Trainings section.