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May 10th 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 May 9th, is available here, and a list of the items shared by LeadingAge NY staff in the webinar chat can be accessed here. If you have questions for next week’s update or would like the access information, please contact Jeff Diamond.

Cross-Sector Updates

FDA Limits Use of J&J Vaccine

On May 5th, the Food and Drug Administration (FDA) issued a Coronavirus Update limiting the Johnson & Johnson (J&J) COVID-19 vaccine to certain individuals age 18 and older for whom other authorized or approved COVID-19 vaccines are not accessible or clinically appropriate and to individuals age 18 and older who elect to receive the J&J vaccine because they would not otherwise receive a COVID-19 vaccine. This limitation is due to the J&J vaccine’s link to rare but serious blood clots.

Individuals are recommended to instead receive mRNA vaccines (Moderna or Pfizer) for their primary and booster shots.

FDA Issues Warning Regarding Counterfeit At-Home COVID-19 Tests

On May 5th, the FDA issued a warning regarding counterfeit at-home, over-the-counter diagnostic tests for COVID-19, which have been found in the United States. These counterfeit tests should not be used or distributed. The FDA website provides information regarding FDA-approved tests and how to identify counterfeit tests.

CDC Holds COCA Call on Evaluating and Supporting Patients Presenting with Cognitive Symptoms Following COVID-19

On May 5th, the Centers for Disease Control and Prevention (CDC) held a Clinician Outreach and Communication Activity (COCA) Call during which presenters discussed post-COVID-19 conditions (PCC), an umbrella term for the wide range of health consequences that are present four or more weeks after infection with SARS-CoV-2, including long COVID. Click here for a recording of the call.

Nursing Home Updates

Reminder to Nursing Homes: CMS 1135 Blanket COVID-19 Waivers Expiring

Nursing homes are reminded that several waivers of federal regulations implemented in response to the COVID-19 pandemic were terminated on May 7th, and additional waivers will be terminated on June 6th. As discussed below, the waiver of the three-day prior hospitalization requirement for Medicare coverage of a skilled nursing facility (SNF) stay remains in effect. Click here for more information.

SNF Three-Day Hospitalization Waiver Still in Place

Members may recall that the SNF Medicare three-day hospitalization stay is among the requirements that are waived during the national Public Health Emergency (PHE). The original waiver findings letter is available here. While the Centers for Medicare and Medicaid Services (CMS) could terminate the waiver earlier, it has been extended each time that the PHE has been extended and therefore is in effect through mid-July. As with the termination of other COVID-19 waivers, we expect that CMS will provide advance notice that either the PHE or the specific waiver is expiring. While efforts are underway to do away with the three-day stay requirement, at this point it appears likely that it will sunset with the PHE. Providers can review the CMS document titled COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, most recently updated on April 7, 2022, to see which waivers remain in effect. The nursing home waivers start on p. 16 and include a list of waivers in effect as well as those that have been rescinded, indicating their end dates.

While the three-day stay waiver is available nationwide and does not require the individual to be impacted by COVID-19, members should be certain to document the reason for its use and ensure that they use the appropriate billing modifiers on their claims. The waiver that allows renewed coverage without a 60-day wellness period is more restrictive and only applies for those beneficiaries who have been delayed or prevented by the PHE itself from commencing or completing the 60-day “wellness period” that would have occurred under normal circumstances. Please keep in mind that the waivers apply to Medicare fee-for-service (FFS) residents; for a Medicare managed care plan, enrollee providers should check with the resident’s Advantage plan on whether the provisions are being waived. General information on billing when waivers are being used is available here, and a LeadingAge National document describing the two payment waivers is here.

Nursing Homes with National Guard Members – PBJ Reporting

If National Guard members have been deployed to your facility, and your facility has trained and is using them as Temporary Nurse Aides (TNAs), the TNA hours worked by these National Guard members may be reported in the Payroll-Based Journal (PBJ) system. To report the National Guard TNA hours, nursing homes should use the following process just approved by the Department of Health (DOH) and New York State National Guard leadership. The nursing home should provide the National Guard Non-Commissioned Officer In Charge (NCOIC) with a document recording the information that will be reported in PBJ, including the Guard members who worked as TNAs and the dates and times they worked. The NCOICs have been authorized to sign these documents. There is no state or federal prescribed form for this purpose; nursing homes should develop their own document. Nursing homes are encouraged to obtain the signature of the NCOIC for TNA hours worked in Q2 2022, as well as Q1, as the deployment will be terminating in May, and it may be difficult to obtain the NCOIC signature once the deployment ends. Providers should keep the signed form as documentation should it be needed for PBJ audit purposes.

Affordable Housing/Independent Living Updates

HUD Extends CSP Capital Project Completion Deadline

In response to advocacy by LeadingAge National and other stakeholders, the Department of Housing and Urban Development (HUD) has extended the deadline to complete capital projects eligible for fourth-round COVID-19 Supplemental Payments (CSPs) to Aug. 30th. The deadline extension will help affordable senior housing providers who were previously approved for fourth-round CSPs to complete eligible capital projects, including installation of internet infrastructure, backup generators, and indoor air system upgrades throughout their portfolios. Click here for more information.