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June 2nd COVID-19 Update

Over the past several days, public health authorities and government regulators have issued new COVID-19-related guidance and requirements for providers of long-term/post-acute care (LTPAC) and senior services. These and other updates are delineated 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 June 1st, 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

June 3rd Relief Funding Deadline for Certain Providers

LeadingAge NY reminds members that June 3rd marks the last day for Medicare providers who may not have received their full Provider Relief Fund (PRF) allocation from the Department of Health and Human Services (HHS) to “apply” for additional funding. This deadline applies specifically to those providers who received funding from the initial $50 billion distributions (one starting April 10th, the second starting April 24th) that is materially less than 2 percent of the all-payer net patient revenue reported on their 2018 Medicare cost report. This issue seems to be most likely to impact providers who filed low-volume Medicare cost reports. Providers in this situation must “apply” by submitting tax and COVID-19-related financial impact information through the attestation portal here. The main HHS PRF page is here. Please note that while HHS materials and guidance have been indicating that all other providers receiving funding have 90 days after receipt of funding to agree to the attached terms and conditions, including submission of required tax and expense information, HHS provided some conflicting information to LeadingAge National late in the day on June 2nd. Should HHS reinterpret the June 3rd deadline in a different way than described above, we will let members know immediately. PRF Frequently Asked Questions (FAQs) are available here.

Coronavirus Financial Assistance Guide Updated

LeadingAge NY has updated its guide, COVID-19 Grants, Loans & Advance Funding Opportunities, which provides members with consolidated summary information on various grants, loans, tax benefits, advance funding opportunities, and other financial assistance available to not-for-profit providers impacted by the pandemic. The guide has been updated to include a new section on mortgage payment relief to Federal Housing Administration (FHA) Section 232-insured nursing home and assisted living facility borrowers, as well as more current information on the Paycheck Protection Program (PPP) and Coronavirus Aid, Relief, and Economic Security Act (CARES Act) funding allocations for Section 8 Project-Based Rental Assistance (PBRA). We will keep members posted on new funding opportunities and revisions to existing programs through updates to the financial assistance guide as needed.

Reopening of Hair Salons/Barbershops, Office Settings, and Dentist Offices

Late last week, New York State issued guidance to businesses under Phase 2 of reopening for eligible regions. Included in Phase 2 are offices and hair salons/barbershops. Dentist offices were permitted to reopen on a statewide basis on June 1, 2020. Executive Order (EO) 202.34, issued on May 28th, extends New York on PAUSE to June 27th subject to the reopening process. LeadingAge NY has asked for, but has not yet received, clarification from the Department of Health (DOH) on whether reopening of hair salons/ barbershops and dental practices has a bearing on whether residents of nursing homes and adult care facilities (ACFs)/assisted living can access these services.

Phase 2 of reopening began on May 30th in the Finger Lakes, Central New York, Mohawk Valley, North Country, and Southern Tier regions and is set to start on June 2nd in Western New York and June 3rd in the Capital Region. Further information for Phase 2 industries is posted on the New York Forward website.

The Phase 2 guidance applies to offices; real estate services; in-store retail; vehicle sales, leases, and rentals; retail rental, repair, and cleaning; commercial building management; and hair salons and barbershops. Each guidance document includes specific requirements and recommendations on social distancing, use of personal protective equipment (PPE), hygiene and cleaning practices, communication, and screening. The guidance also includes Read and Affirm detailed guidelines and a Business Safety Plan Template. Please note that this guidance applies to both essential and non-essential businesses, each of which must affirm compliance.

Dental practices statewide can reopen as of June 1st while adhering to best practices for safety and social distancing guidelines. The Interim Guidance for Dentistry During the COVID-19 Public Health Emergency provides dental health care personnel with precautions to help protect against the spread of COVID-19 as dentistry facilities reopen or continue to operate for elective and emergency procedures. This guidance applies to all dental care, including emergency and non-emergency/elective care.

These guidance documents for each industry type also reflect a 50 percent occupancy requirement, which limits worker and customer presence to 50 percent of the maximum occupancy of the space as determined by the certificate of occupancy. The guidance also includes further information on what to do if an employee has COVID-19 symptoms or has been exposed to COVID-19.

For a business to reopen in its designated phase, it “…must develop a written Safety Plan outlining how its workplace will prevent the spread of COVID-19. A business may fill out [this plan template] to fulfill the requirement, or may develop its own Safety Plan. This plan does not need to be submitted to a state agency for approval but must be retained on the premises of the business and must be made available to the New York State Department of Health (DOH) or local health or safety authorities in the event of an inspection.”

Nursing Home and ACF Updates

Staff Testing Insights Needed

The costs and operational challenges of the staff testing mandate in its current form continue to be major concerns for members. LeadingAge NY asks nursing home and ACF/assisted living members to help in our advocacy efforts by completing our online 10-Minute Staff Testing Survey issued on June 1st. We realize that members have a high level of survey fatigue and promise not to subject you to any but the most critical requests. For those who have yet to complete it, we ask that you do so at your first opportunity. The questions require no research, and data collected will be used only in the aggregate. To access the survey, click here. Your input will assist in our ongoing advocacy efforts for a rational testing strategy and for reimbursement of testing costs. We thank those who have already shared their information.

CMS Plans Increased Infection Control Surveys and Enforcement

Click here for information on the Centers for Medicare and Medicaid Services’ (CMS) newly issued memorandum outlining nursing home survey priorities.

CMS to Post COVID-19 Data on Nursing Home Compare

In a June 1st news release, CMS announced that it will be posting COVID-19 data in a downloadable format on Nursing Home Compare later in the week. This data is derived from information that nursing homes have been reporting to the CDC. It includes the state and the number of resident and staff cases and deaths related to COVID-19. The data, which CMS is planning to update weekly, will be searchable by the public.

For a state-by-state breakdown of nursing home COVID-19 data, click here.

CMS to Review Implementation Strategies for COVID-19 Surveillance and Early Detection During June 4th Webcast

On June 4th from 4 to 5 p.m. ET, CMS will stream the first session of its new National Nursing Home Training Series, a weekly series focused on infection prevention in the nursing home setting. This week’s webcast, “Implementation Strategies for COVID-19 Surveillance and Early Detection,” will review the operational aspects of screening, testing, and early detection and surveillance for residents and staff from the provider perspective. The training focus will be on process and implementation and include an overview of the IPRO Quality Innovation Network-Quality Improvement Organization (QIN-QIO)-developed Infection and Antibiotic Prescribing Tracking Tool.

Advance registration is required and may be done here.

Home and Community-Based Services (HCBS) Updates

COVID-19 Testing of Home Care and Hospice Workers in Nursing Homes and ACFs

As members are aware, DOH recently released two FAQ documents regarding staff testing requirements for nursing homes and ACFs. The newer version differs significantly regarding testing of home care and hospice workers serving patients in these facilities.

The first FAQ, issued on May 12th, stated that licensed home care services agency (LHCSA), certified home health agency (CHHA), and hospice staff visiting facilities would not have to undergo the testing requirement. A new provision in the FAQ issued on May 19th eliminates the exemption:

1. Who must be tested?

All employees, contract staff, per diem staff, medical staff, operators, administrators, and volunteers must be tested. Staff who are working from home, on leave, or otherwise not at the same site as residents, do not need to be tested so long as they remain offsite.

While the Department has not issued any official clarification regarding this new change, please note that DOH staff has communicated via email that the original exemption for home care and hospice staff has been eliminated, and home care and hospice staff delivering services in ACFs and nursing homes are now subject to the testing requirement. An email states: “Any personnel entering the facility, contract or otherwise, need to be tested, including Art. 36/Art. 40 personnel.”

We have urged DOH to issue a communication or guidance document on this policy change directly to home care and hospice providers, noting its significance from both an operational and financial perspective. It is unclear whether the Department will do so.

To clarify, this issue only applies in cases where a home care or hospice agency has staff serving in a nursing home or ACF. Staff must be tested twice per week if they work four days or more a week and once per week if they work there three days or less. Staff serving in more than one facility are required to be tested twice per week. Documentation of test results may be shared with multiple facilities.

COVID-19 Considerations Must Be Incorporated into Home Care Aide Training Programs

DOH has issued guidance requiring home care agencies with an approved personal care aide or home health aide training program (PCATP/HHATP) to develop a Policy and Procedure for their Policy and Procedure Manuals incorporating the training requirements noted below. This policy should be developed prior to initiating resumption of training. The agency must consider the information listed below for each training modality that the agency intends to offer/resume: for HHATP – Core Training, Nurse Aide Transition, PCA Upgrade, Competency Evaluation; and for PCATP – Basic Training, Alternative Competency Demonstration.

Agencies must take the following into consideration when resuming training classes: 

  • The impact of CDC social distancing guidelines on classes; 
  • How to eliminate or reduce the potential/risk of virus transmission in the classroom and skills lab settings; 
  • Developing a process for screening trainees for symptoms, including, but not limited to, temperature checks prior to entering classroom and skills lab settings;
  • How to ensure the availability of PPE for trainees and trainers, as well as all supplies for training purposes;
  • How to meet the 16-hour supervised practical training requirement for home health aide training conducted in the skills lab setting. (As noted in the Department’s April 10th Interim Guidance for HHATPs, all 16 hours of the required supervised practical training must be conducted in the skills laboratory, under the direct supervision of an approved Nurse Instructor. Information can be found on the Health Commerce System (HCS).)

Any questions or concerns may be submitted to the following email addresses, with a cc to your regional office:

CDC Issues New Guidance for HCBS Providers 

The CDC recently issued the following guidance for a variety of HCBS workers providing information on COVID-19’s impact on their work and their clients’ health and well-being:

Affordable Housing/Independent Living Updates

HUD Issues New Guidance Allowing for Electronic Signatures and Documents

On May 26th, the Department of Housing and Urban Development’s (HUD) Office of Multifamily Housing published guidance for the use of electronic signatures, as well as file storage and transmission, in HUD-assisted multifamily housing in order to help communities minimize COVID-19 exposure for staff and residents. For analysis of the new guidance from LeadingAge National, click here.

HUD Announces CARES Act Allocation for Project-Based Communities

On June 1st, HUD published a funding allocation update on COVID-19 relief from the CARES Act. Of the $1 billion approved for PBRA, HUD will complete $800 million in funding allocations during the week of June 1st to help communities prevent, prepare for, and respond to COVID-19 through regular operations. Click here for more information.