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March 24th COVID-19 Update

In recent days, public health authorities and government regulators have issued new guidance and requirements related to the COVID-19 outbreak for providers of long-term/post-acute care (LTPAC) and senior services. These and other updates are outlined in detail 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 March 23rd, can be accessed here. Please send any questions to Ami Schnauber, and check your email for the dial-in information, or contact Jeff Diamond. In addition, LeadingAge NY has just released updated questions and answers (Q&As) on operational and regulatory issues related to COVID-19. The updated Q&As include information on a variety of issues, including personal protective equipment (PPE) conservation guidance, employee screening and restrictions, testing, visitation, regulatory waivers, and child care access, as well as issues specific to nursing homes, adult care facilities (ACFs)/assisted living, adult day health care (ADHC), home and community-based services (HCBS), and affordable housing/independent living. Click here to access the Q&As.

Cross-Sector Updates

LeadingAge NY Submits Federal Waiver Requests to the State

LeadingAge NY has submitted recommendations to the Department of Health (DOH) on statutory and regulatory flexibilities that the federal government could provide under Section 1135 of the Social Security Act. Our Section 1135 waiver requests cover general areas, as well as flexibilities specific to nursing homes, home health agencies, and hospices. The State submitted its first Section 1135 waiver request on March 23rd, joining several other states.

On March 13th, the President issued a proclamation that the COVID-19 outbreak in the United States constitutes a national emergency. On the same day, the Secretary of Health and Human Services invoked his authority under Section 1135 to waive or modify certain Medicare, Medicaid, and Child Health Plus requirements to mitigate the consequences of the COVID-19 pandemic, as determined by the Centers for Medicare and Medicaid Services (CMS). The aim is to ensure that sufficient health care items and services are available to meet the needs of enrolled individuals and to ensure that health care providers that furnish such items and services in good faith, but are unable to comply with one or more of such requirements as a result of the pandemic, may be reimbursed for these items and services. The Section 1135 waiver authority took effect as of March 15th, with a retroactive effective date of March 1st. The emergency period will end, and waivers will no longer be available, upon termination of the public health emergency, including any extensions.

States/territories can request approval that certain statutes and implementing regulations be waived by CMS, pursuant to Section 1135 of the Act. As of the date of this publication, 13 states have received 1135 waivers covering general program areas including provider enrollment, prior authorization, fair hearings, and providing services in alternative settings. New York submitted a Section 1135 waiver request on March 23rd, and we expect that the State will seek additional flexibilities.

DOH to Provide Medicaid Application and Recertification Flexibility During COVID-19 Crisis

DOH announced on a March 24th call that Medicaid cases due to recertify during the federal state of emergency will be extended for 12 months. In addition, new applicants can attest to all eligibility criteria except nationality and citizenship. Any pended cases, including those pended for documentation of nationality and citizenship, will be extended during the emergency. Additional written guidance is forthcoming.

DOH is currently working on updating the March 18th COVID-19 Guidance for the Authorization of Community Based Long-Term Services and Supports Covered by Medicaid. It intends to update the guidance to respond to many questions posed by long-term care (LTC) providers and Managed Long Term Care (MLTC) plans, including issues around when in-person assessments are warranted, limits on the ability to mail plans of care, and flexibility in care management requirements.

LeadingAge NY will post the written guidance as soon as it is made available.

Suspension of Certain Insurance Pre-Authorizations

The Department of Financial Services (DFS) is urging all health insurers, including managed care plans, to suspend pre-authorization requirements for home health and inpatient rehabilitation services for 90 days. DFS issued guidance to insurers that they should suspend pre-authorization and administrative requirements, including certain utilization review and notification requirements. The guidance, developed in collaboration with the insurance industry and hospitals, is aimed largely at hospital services but addresses home care and nursing home rehabilitation services as well.

Specifically, DFS Circular Letter No. 8 advises insurers to suspend pre-authorization review for home health care services and inpatient rehabilitation services following an inpatient hospital admission. The guidance also specifies administrative requirement flexibility in a number of areas for hospitals and, to the extent currently required, suspension of pre-authorization review for inpatient rehabilitation services following an inpatient hospital admission for mental health and substance use disorders.

DFS indicates that it is closely monitoring the development of COVID-19 and will continue to consider additional suspensions or regulatory relief as appropriate and needed for regulated institutions impacted by the challenges of COVID-19. The guidance letter will remain in effect for 90 days but is subject to further evaluation as the situation develops. Please note that while CMS is urging Medicare Advantage plans to provide flexibilities during the emergency, DFS guidance typically does not cover Medicare plans. A copy of the letter is available here. The CMS guidance issued to Medicare Advantage organizations on March 10th is accessible here.

Comprehensive Guidance Issued Regarding Telehealth and Telephonic Services During COVID-19 State of Emergency

On March 23rd, DOH issued a Medicaid Update entitled Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services During the COVID-19 State of Emergency. The guidance offers many different Medicaid providers flexibility and will likely be updated during this current state of emergency. Please check back often for updates. A webinar and Frequently Asked Questions (FAQ) will be issued on this guidance soon. 

The guidance addresses the following:

  • services allowed
  • applicable provider types
  • fee or rate 
  • setting
  • rate or procedure codes
  • additional notes or commentary

The intent of the guidance is to provide broad expansion for the ability of all Medicaid providers in all situations to use a wide variety of communication methods to deliver services remotely during the COVID-19 state of emergency, to the extent it is appropriate for the care of the member. Telehealth services will be reimbursed at parity with existing off-site visit payments (clinics) or face-to-face visits (i.e., 100 percent of Medicaid payment rates).

This guidance relaxes rules on the types of clinicians, facilities, and services eligible for billing under telehealth rules. Additionally, it addresses some technological barriers to telehealth by allowing clinicians and health care organizations to bill for telephonic services if they cannot provide the audiovisual technology traditionally referred to as “telemedicine.”

This guidance replaces previously issued guidance regarding telehealth and telephonic communication services during the COVID-19 state of emergency (Medicaid Update March 2020 Vol 36, Numbers 3 and 4).

CMS Issues Memorandum to State Survey Directors and Infection Control Survey Guidance

On March 23rd, CMS issued a memorandum to state survey directors regarding survey prioritization with focus on infection control to ensure that facilities follow infection control regulations and requirements to mitigate the spread of COVID-19. CMS and the Centers for Disease Control and Prevention (CDC) have developed and are disseminating their infection control survey so that facilities can educate themselves on the latest practices and expectations. They expect facilities to use this new process, in conjunction with the latest guidance from the CDC, to perform a voluntary self-assessment of their ability to prevent the transmission of COVID-19.

Please contact Dawn Carter, RN, LeadingAge NY ProCare Consultant, at dcarter@leadingageny.org with any questions on the memorandum.

CDC Develops LTC COVID-19 Preparedness Checklist

The CDC has made available a new COVID-19 preparedness checklist for nursing homes and other LTC settings.

Per the CDC:

“Each facility will need to adapt this checklist to meet its needs and circumstances based on differences among facilities (e.g., patient/resident characteristics, facility size, scope of services, hospital affiliation). This checklist should be used as one tool in developing a comprehensive COVID-19 response plan…[it] identifies key areas that long-term care facilities should consider in their COVID-19 planning. Long-term care facilities can use this tool to self-assess the strengths and weaknesses of current preparedness efforts. Additional information is provided via links to websites throughout this document. However, it will be necessary to actively obtain information from state, local, tribal, and territorial resources to ensure that the facility’s plan complements other community and regional planning efforts.”

For questions on the checklist, please contact Dawn Carter at dcarter@leadingageny.org.

HCBS Updates

New Home Care and Hospice Guidance

This March 22nd DOH guidance for home care and hospice providers supersedes guidance previously issued on March 14th. It eliminates the screening questions relating to international travel. It also requires agencies to screen staff daily and staff to self-monitor their condition before arriving to cases. Agencies must also establish a plan for distribution of supplies to staff that avoids staff congregation. While this guidance supersedes the previous policy, there are some components of the initial policy that were fairly important – one being the process for referring patients with symptoms or infection to the local health department (LDH) and primary care physician. LeadingAge NY will clarify with the Department whether these should remain in place.

NHTD/TBI Guidance

This guidance offers significant telehealth/telephonic options for waiver service providers. It also provides some changes to service coordination (SC) and cancels SC supervisory visits. Providers will need to work out some alternatives with the Regional Resource Development Center (RRDC) for those participants utilizing structured day programs. The document also addresses the process for eligibility and admission to the waiver from the community or a nursing home. All annual Community Health Assessment (CHA) reassessments are suspended, and all training may be performed telephonically or via telehealth.

HCBS Waiver Amendment

These CMS resources pertain to the opportunity for states to apply for amendments to their 1915(c) HCBS waivers. DOH will likely be putting together amendments to this waiver to enable safer, expedited, and more efficient delivery of HCBS during the state of emergency. Please let LeadingAge NY know if you have recommendations that we can suggest to DOH. The amendment will allow changes regarding added services, provider qualifications, new settings, and more. 

Transportation Guidance

This guidance was issued to the Department’s transportation managers and brokers on March 21st.

Housing Updates

HUD to Host Second National COVID-19 Call on March 26th

On March 24th, Department of Housing and Urban Development (HUD) Office of Multifamily Housing Deputy Assistant Secretary Lamar Seats announced plans to host a second national call to address the Office’s COVID-19 response on Thurs., March 26th from 2:30 to 3:30 p.m. ET. Please submit questions in advance of the call to MFCommunications@hud.gov and use the following dial-in information to join: 844-867-6169, 882 3979.