June 9th 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 8^th, is available here. In addition to updates from LeadingAge NY staff, this week’s webinar includes a presentation on COVID-19 billing and accounts receivable support from Israel Rosenberg, chief operating officer at Comprehensive Healthcare Solutions. 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 Lawmakers Authorize PPP Flexibility for Small Businesses

On June 5^th, President Trump signed the Paycheck Protection Program (PPP) Flexibility Act into law. This legislation provides many small businesses with greater flexibility in how they spend federal loans made under the PPP.

This new law makes the following changes:

Spending Timeframe: The covered period to spend the loan proceeds is extended from eight weeks from the dispersal date of the loan to the earlier of 24 weeks or Dec. 31, 2020. This has no bearing on the amount of the PPP loan, only the amount of time that borrowers must spend it and receive loan forgiveness. Businesses that received a loan prior to June 5^th can still elect to use an eight-week period rather than the expanded period.
Payroll Threshold: The percentage of the loan amount that must be allocated to payroll costs was reduced from 75 percent to 60 percent. Employers can use the remaining 40 percent for nonpayroll expenses such as covered rent, mortgage interest, and utilities costs. However, the 60 percent standard is a “hard threshold.” In other words, if the threshold of 60 percent of payroll costs is not reached within the allowed 24 weeks, there will be zero loan forgiveness (unlike the 75 percent standard, which allowed partial forgiveness).
Safe Harbor: The “safe harbor” to restore the level of full-time equivalent workers and salary levels that existed as of Feb. 15, 2020 for loan forgiveness purposes was extended from June 30^th to Dec. 31^st. In addition, the amount of loan forgiveness will not be reduced due to a loss of employees if the borrower can document its inability to hire or rehire qualified new employees or its inability to return to its pre-Feb. 15^th operating levels resulting from compliance with Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), and Occupational Safety and Health Administration (OSHA) requirements related to COVID-19.
Loan Term: The amount of the PPP loan that is not forgiven can be extended from a two-year loan term up to a five-year term. The interest rate remains at 1 percent.
Social Security Tax Deferral: Employers who obtain forgiveness of a PPP loan may now defer all Employer Social Security tax deposits that would otherwise have been required to be deposited prior to Jan. 1, 2021.

These revisions to the PPP may be beneficial to waiting further details and guidance from the Small Business Administration (SBA). There is well over $100 billion in PPP funding authority currently available for those members interested in applying.

NYC DOHMH Winding Down PPE Distribution, Holding PPE Purchasing and Capacity Building Webinar TOMORROW

The New York City Department of Health and Mental Hygiene (NYC DOHMH) has announced that it will be winding down its distribution of personal protective equipment (PPE) in June. It is encouraging providers to bolster their vendor relationships to obtain adequate PPE.

To support that goal, NYC DOHMH is offering a webinar for NYC providers tomorrow, June 10^th, from 2 to 3 p.m. concerning PPE purchasing and capacity building. The webinar is intended to provide “a refresher on guidance for the use of personal protective equipment (PPE), inform agencies and providers how to calculate a burn rate, and share considerations and best practices for purchasing PPE.” It is targeted at providers with more limited experience purchasing PPE. Registration is available here.

Nursing Home and Adult Care Facility (ACF) Updates

TOMORROW at 10 A.M.: DOH to Host Webinar Regarding Weekly Nursing Home and ACF Staff Testing Survey

Tomorrow, June 10^th, at 10 a.m., the Department of Health (DOH) will host a 45-minute webinar for nursing homes and ACFs regarding the weekly staff testing survey related to measures taken by facilities to meet the terms of Executive Order (EO) 202.30 and specifically staff testing. Members should be sure to check their email for the webinar access information from DOH and submit any questions to covidadultcareinfo@health.ny.gov or covidnursinghomeinfo@health.ny.gov.

Infection Control Survey Data Link Posted to Nursing Home Compare

On June 9^th, the Centers for Medicare and Medicaid Services (CMS) posted a link to the Nursing Home Infection Control Survey results on Nursing Home Compare (NHC), in the Spotlight section.

Selecting the link will download zip files that contain PDFs with the results of the survey for each nursing home on the standard Statement of Deficiencies (SOD) form. Also contained in the download are two Excel spreadsheets, one searchable by facility and containing the tag, level of harm, and number of residents affected, and the other containing the number of surveys for each state and the nation.

Home and Community-Based Services (HCBS) Updates

DOH Halts LHCSA COVID-19 Survey

DOH last week halted the weekday survey for licensed home care services agencies (LHCSAs) which tracked patient caseloads, staffing, and PPE needs. LeadingAge NY will be requesting results from the survey in order to better prepare for additional waves of COVID-19.

NHTD/TBI Appendix K Flexibilities During COVID-19

CMS has granted DOH approval of changes to the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) 1915(c) waivers during the COVID-19 State of Emergency. The Appendix K changes are effective from March 1, 2020 through Feb. 28, 2021. Some of the flexibilities relating to telehealth and telephonic services were addressed in previous guidance. Appendix K also includes a two-month delay in the deadline regarding compliance with the federal Conflict of Interest (COI) rule, which prohibits service coordinators from delivering waiver services and service coordination to the same individual. The following flexibilities are also included:

Allowing specific service limits to be exceeded for the TBI program (already allowed under the NHTD program);
Expanding settings for services to the home or emergency residential settings (i.e., hotel);
Allowing Initial Level of Care assessments, service planning, and team meetings to be completed by telehealth or telephone;
Allowing e-signatures and verbal consent with documentation and confirmation processes in place;
Providing options regarding serious reportable incidents;
Extending various reporting requirements;
Allowing certain providers to bill retainer payments at existing rates; and
Making service changes to suspend or delay certain requirements.

The document can be accessed here. Questions on the approved waiver may be addressed to waivertransition@health.ny.gov.