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June 8th 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 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 June 7th, 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.

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

DOH Issues Updated ACF Visitation Guidance

The Department of Health (DOH) issued updated visitation guidance for ACFs dated June 3rd, which is accessible here. We encourage you to review the guidance carefully but provide a summary of its key aspects here.

DOH Issues Emergency Personal/Compassionate Caregiving Regulations for Nursing Homes and ACFs

Last week, DOH issued regulations on an emergency basis to implement the legislation establishing personal caregiving and compassionate caregiving visitors in nursing homes and ACFs. To date, we have not seen any Dear Administrator Letter (DAL) or additional official guidance from DOH regarding the implementation of the regulations, which were effective June 1st. The legislation, signed by the Governor last month, allows residents of ACFs and nursing homes to identify at least two personal caregiving visitors or compassionate caregiving visitors to assist with personal caregiving or compassionate caregiving for the resident during a public health emergency. Click here for more information.

Transition of Temporary Nurse Aides to CNAs Under Discussion

DOH is consulting with LeadingAge NY and other associations concerning the requirements that will be applied to temporary nurse aides (TNAs) who seek to become certified nurse aides (CNAs) once the 1135 waiver expires and they are no longer permitted to work without certification. The Centers for Medicare and Medicaid Services (CMS) has signaled that the 1135 waiver will be terminated when the public health emergency is discontinued, which could be as early as this summer. Once the waiver is terminated, according to CMS, the TNAs will be required to obtain their certification within four months, in order to continue performing the duties of a CNA.

LeadingAge NY and the other associations are discussing with DOH the credit that should be conferred on TNAs for the training they have already completed and clinical experience they have gained as TNAs. We appreciate the responses of the members to our TNA survey and are using the data gathered to frame our input into these discussions. The Department is also working to ensure that Prometric Nurse Aide Training Program (NATP) tests are administered promptly when requested. Facilities that are experiencing delays in securing the Prometric test should contact DOH here.

LeadingAge NY Speaks on Emergency Regs, Testing, and Visitation at State PHHPC Meeting

Following our submission of written comments on the State’s emergency regulations requiring a 60-day stockpile of personal protective equipment (PPE) for nursing homes and the arrangement of COVID-19 vaccination for nursing home and ACF staff and residents, LeadingAge NY spoke at the June 3rd meeting of the Public Health and Health Planning Council’s (PHHPC) Committee on Codes, Regulations and Legislation. We reiterated our position that the April 2020 timeframe for measuring the adequacy of PPE inventory is inappropriate and asked the State to align its vaccination regulation and other guidance with federal requirements. We highlighted the confusion and inefficiencies created as a result of the inconsistent and duplicative guidance issued by State and federal authorities. In his remarks to the Council, DOH Commissioner Dr. Howard Zucker solicited suggestions for incentives to encourage vaccine acceptance. We pointed out that exempting vaccinated nursing home and ACF staff from serial screening tests would provide a strong incentive for staff to get vaccinated. We also called for the State to lift social distancing and masking requirements for vaccinated nursing home residents and their visitors. Our written comments are available here, and a portion of our oral remarks is here. A recording of the entire meeting 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. While Lewis County remains above 5 percent based on federal data, state figures indicate no county with a positivity rate above 3 percent. Note that the federal positivity rate calculation excludes point-of-care tests. 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. LeadingAge NY extracts the CMS-calculated rates for New York State counties and posts 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. Staff vaccination rates continued to inch upward, with the statewide nursing home staff vaccination rate reaching 62 percent and the ACF rate hitting 70 percent. Over 94 percent of ACF residents are vaccinated, while the nursing home resident vaccination rate is 85 percent. The rates are based on daily Health Emergency Response Data System (HERDS) reporting and can be accessed here.

Submit Vaccination Data This Week to Avoid Penalties!

With this week’s submission, CMS will begin enforcing the requirement that nursing homes submit resident and staff vaccination status data through the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN). Nursing home providers need to submit complete data at least once during this week (i.e., June 7th through 13th) and at least once per week going forward to be compliant with the new requirement. Providers must indicate how many of their total workers and residents received vaccine (by dose and type), for how many the vaccine was medically contraindicated, and whether the facility has sufficient access to vaccine to offer it to staff during the reporting week. Vaccination status must be listed for all staff and residents, whether they received their vaccination at the facility or elsewhere.

Data must be reported for any health care personnel (employee, contractor, student, trainee) who were eligible to have worked at least one day during the reporting week and for any resident who was in the facility for at least one 24-hour day during the week. Detailed reporting instructions and the list of reporting items are posted here in the “Data Collection Forms and Instructions” section. A recording of the educational session provided by the CDC is available here. Links to the training presentation slides as well as a helpful set of Frequently Asked Questions (FAQs) are available on the CDC COVID-19 Vaccination site.

NHSN reporting weeks run from Monday through Sunday, and providers may submit the data on the day of their choice, as long as it is done at least once during each Monday through Sunday week. Reporting of COVID-19 therapeutics administered to residents for treatment of COVID-19 is also now mandatory. Instructions for that pathway are on the main LTCF COVID-19 Module page under “Therapeutics.”

We ask members who encounter any problem with submitting data to let us know. LeadingAge National is recommending that providers seeking to add Secure Access Management Services (SAMS) Level 3 users use the SAMS support line, 877-681-2901, or email samshelp@cdc.gov.

Psychological First Aid and Resilience

The Institute for Disaster Mental Health at SUNY New Paltz is offering two free training modules, Psychological First Aid and Personal Resilience and Stress Inoculation. As we move through the second year of the COVID-19 emergency, everyone continues to grapple with a complex and ever-changing combination of acute and chronic stressors, which can take a toll on our ability to function professionally as well as impact our personal mental health.

Psychological First Aid is an early intervention that can be used to support anyone who is stressed or distressed, including patients, clients, and colleagues. This training will present a toolkit of supportive elements that can be used to help others, regardless of the setting or source of the stress, in order to remove barriers to natural resilience.

Personal Resilience and Stress Inoculation training will take an applied focus on understanding how to manage stress, with an emphasis on building and maintaining resilience through cognitive approaches including Stress Inoculation.

Registration information and training dates can be viewed in the links above.

Home and Community-Based Services (HCBS) Updates

LeadingAge NY Provides Recommendations to DOH on Enhanced HCBS FMAP Funding

On June 4th, LeadingAge NY submitted our recommendations to DOH regarding the enhanced Federal Medical Assistance Percentage (FMAP) for HCBS made available through the American Rescue Plan. Click here for more information.