July 21st 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 outlined 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 20th, 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.
CARES Act Medicaid Funding
The Department of Health and Human Services (HHS) has just announced a two-week extension to apply for a distribution under the $15 billion Coronavirus Aid, Relief, and Economic Security Act (CARES Act) Provider Relief Funding allocation for Medicaid and Children’s Health Insurance Program (CHIP) providers. This program is aimed at Medicaid providers that did not receive a payment from the $50 billion Provider Relief General Distribution. HHS has extended the deadline for eligible providers to apply for this funding until Aug. 3, 2020.
Assisted living facilities, home and community-based services (HCBS) providers, nursing facilities, clinics, and hospices can apply if they meet certain criteria. HHS recently clarified that Programs of All-Inclusive Care for the Elderly (PACE) are not eligible for the Medicaid and CHIP distribution. Each successful applicant will receive a grant of at least 2 percent of its reported gross revenue from patient care. Applications are being processed on a rolling basis, so it makes sense to apply as soon as possible before the deadline.
Materials, a recorded webinar, updated Frequently Asked Questions (FAQs), and access to the application portal are posted on HHS’s CARES Act Provider Relief Fund webpage. The LeadingAge NY COVID-19 Financial Assistance Opportunities for Not-for-Profit (NFP) Providers guide provides the most updated information on this program and other financial assistance for members.
Main Street Lending Program
On July 17th, the Federal Reserve (Fed) unveiled long-awaited changes to the Main Street Lending Program to support greater access to credit for NFPs such as health care providers, educational institutions, and social service organizations. The Fed approved two new loan options to support those NFP organizations that were financially strong prior to the pandemic.
The Main Street NFP loan terms generally mirror those for Main Street for-profit business loans, including the interest rate (LIBOR + 300bp), two-year principal and one-year interest payment deferral, five-year term, and loans between $250,000 and $35 million under the new loan option. Borrowers that are using the Paycheck Protection Program (PPP) may use Main Street if they meet the eligibility requirements for both.
However, the program has stringent financial requirements. To qualify, an NFP must have:
- 2019 operating margin of 2 percent or more;
- Current days cash on hand of 60 days; and
- Ratio of cash, investments, and other resources to outstanding debt and certain other liabilities of greater than 55 percent.
The Fed and Federal Reserve Bank of Boston webpages provide updated information on the program, including term sheets and forms/agreements for the lending options and an FAQ document. The LeadingAge NY COVID-19 Financial Assistance Opportunities for NFP Providers guide also provides updated information on this program.
New CDC Return-to-Work Guidance Differs from DOH Guidance
Last week, the Centers for Disease Control and Prevention (CDC) modified its return-to-work guidance in recognition of research showing that there is prolonged shedding of the virus by people who are no longer infectious. Given the prospect of repeat positive tests among people who are not infectious, it recommends a symptom-based return-to-work strategy rather than a test-based strategy. Notably, the New York State Department of Health (DOH) has not modified its return-to-work guidance, which, for nursing home and adult care facility (ACF) staff, combines both a 14-day quarantine and a negative test to return to work. Since DOH is charged with regulatory oversight of long-term care providers, whereas the CDC principally issues recommendations, long-term care providers should continue to follow DOH guidance. Click here for more information.
CMS Further Extends Medicare Cost Report Deadline
The Centers for Medicare and Medicaid Services (CMS) has further extended the Medicare cost report filing deadline. Medicare providers (all provider types) who operate on a calendar fiscal year (FY) now have until Aug. 31, 2020 to submit their 2019 Medicare cost report. CMS had previously extended the original due date of May 31st for these providers to July 31st and is now extending the due date by an additional month. The previously announced extensions for providers who operate on a FY other than the calendar year remain unchanged: organizations with FYs ending on Jan. 31st have until Aug. 31st, while those with FYs ending on Feb. 29th have until Sept. 30th to file. The dates are set out on page 94 of the CMS document entitled COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing (updated July 15th).
New York Adds 10 States to Travel Advisory
LeadingAge NY has been tracking the COVID-19 Travel Advisory requiring people to quarantine if traveling to New York from certain states, with certain conditional exceptions for essential workers. On July 21st, the Governor announced that 10 new states have been added to the list: Alaska, Delaware, Indiana, Maryland, Missouri, Montana, North Dakota, Nebraska, Virginia, and Washington. Minnesota has been removed from the list. Click here for more information and an archived list of states as they have been added or removed.
LeadingAge NY to Host FEMA Webinar on July 23rd
LeadingAge NY is pleased to bring you another in our series of free webinars addressing current issues in the COVID-19 environment. We hope you will join us this Thurs., July 23rd, from 11 a.m. to 12 p.m. for a webinar on the Federal Emergency Management Agency (FEMA) Public Assistance Program Application Process. Registration is available here.
The webinar will feature officials from the New York State Division of Homeland Security and Emergency Services (DHSES) discussing the application process for FEMA funding and common issues affecting NFP and public long term care providers as they navigate the process. Members will learn how to determine whether their organization is eligible, what expenses are eligible for FEMA reimbursement, and how to seek reimbursement. The possibility of reimbursement for staff testing costs will also be covered.
COVID-19 Webinar Resources
For those who may have missed it, a recording of LeadingAge NY’s July 14th webinar entitled “NYS COVID-19 Paid Sick Leave Law: When Do You Have to Pay Your Employees?” is now available here. To access our other COVID-19-related webinar resources – including recordings of our Monday webinars, other HR-related COVID-19 webinars, the Adult Day Health Care Council’s (ADHCC) webinar series on Adult Day Health Care business sustainability and recovery during COVID-19, and LeadingAge NY ProCare's infection control webinars – click here.
Nursing Home and ACF Updates
Instructions for NHSN COVID-19 Reporting
Nursing home members should be certain to complete their National Healthcare Safety Network (NHSN) COVID-19 reporting accurately and to refer to the detailed instructions provided when doing so. Because the absence of staffing shortages as reported to NHSN is among the criteria for nursing homes to allow visitors, providers should be aware that the use of temporary staff does not in itself count as a staffing shortage for NHSN reporting purposes. The instructions for the Staff and Personnel Impact reporting pathway are available here. The Long Term Care Facility COVID-19 reporting page that contains information and links to instructions for all domains is here. Homes may submit data as frequently as they like, but no less frequently than once a week. CMS indicates that all but 40 homes in New York State submitted data for the week ending July 5th. Homes that fail to report are also prohibited from allowing visitors.
HHS Distribution of Tests Raises CLIA-Waived Testing Questions
The federal government announced last week that it would be distributing rapid point-of-care diagnostic test instruments and tests to nursing homes in COVID-19 hotspots. Nursing homes in New York State are not likely to be prioritized for distribution but may nevertheless wish to add the point-of-care tests to their New York State Limited Service Laboratory Registration. Click here for more information.
Civil Monetary Penalty Reinvestment Funds Available to Nursing Homes
CMS recently developed an application template for nursing homes to apply for Civil Monetary Penalty (CMP) Reinvestment funds for the purchase of communication devices to facilitate communication between residents and families. Click here for more information.
DOH Issues Guidance on Nursing Home Resident Transfers
On July 17th, DOH issued Dear Administrator Letter (DAL) NH 20-03 reminding nursing homes of their obligation to notify their DOH regional office prior to the transfer of a resident under certain circumstances. Click here for more information.
Update on Opening of Daily Nursing Home/ACF HERDS Survey
LeadingAge NY is aware that the daily nursing home/ACF Health and Emergency Response Data System (HERDS) survey was issued later than expected this past weekend. DOH has affirmed that the survey will be opened around 8 a.m. daily, including on the weekends, moving forward, per member request.
DOH Seeking Input on Virtual Training Options for Home Health Aide and Personal Care Aide Training Programs
In light of the COVID-19 pandemic, DOH is seeking to provide flexibilities relating to remote/virtual training options for Home Health Aide and Personal Care Aide Training Programs. They are seeking input relating to the following 12 areas:
- Technology and method;
- Instructor willingness;
- Experience and capacity of students to access and to use effectively;
- Ability to interact with instructors, ask questions, and obtain feedback;
- Skill training, method, and site for instruction;
- Access to equipment needed for training;
- Number of students per class;
- Instructional materials, including textbook;
- Languages for instruction;
- Process for approval; and
LeadingAge NY is asking members to provide feedback that we can offer to the Department. Please contact Meg Everett at email@example.com.