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Nov. 24th 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 Nov. 23rd, 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

Travel Guidance Reminder

With the holidays upon us and the potential for travel among staff, as well as potential family visits with residents, we wanted to remind members of the current travel guidance. On Nov. 4th, the State implemented a new travel advisory policy that replaces the weekly list of states – which had grown to encompass nearly the whole country – with a new test-based strategy. Under the new policy, travelers coming to New York from states that are not contiguous to New York, or after travel to any Centers for Disease Control and Prevention (CDC) Level 2 or Level 3 Travel Health Notice country, must quarantine for 14 days unless they satisfy the test-based requirement to exit quarantine early.

“Essential workers” are exempt from this policy and, absent updated guidance, should continue to follow provider-specific guidance for the conditions under which they can return to work. Additionally, adult care facility (ACF) and nursing home staff must obtain a negative test result before returning to work. Click here for more information.

Nursing Home and ACF/Assisted Living Updates

DOH Issues Holiday Guidance for Nursing Homes and ACFs

On Nov. 24th, the Department of Health (DOH) issued guidance related to nursing home and ACF residents leaving the building for the holidays. It largely tracks the Centers for Medicare and Medicaid Services (CMS) guidance previously shared with members, with some important mandates. The guidance is clearly meant to discourage residents from leaving the building and contains onerous provisions upon return for any that chose to leave. Click here for more information.

Local Positivity Rates

The most recent listing of 14-day testing positivity rates for each county in New York State from CMS is available here. As of this week, Allegany County is the only county above the 10 percent CMS threshold. Current daily county-level data for New York State are here, and ZIP-code level data for New York City (NYC) showing infection rates during the most recent four weeks are available here. Metrics related to the State’s micro-cluster initiative are available here, and an address look-up tool is here.

More Changes to NHSN Reporting

The CDC has made reporting changes to the COVID-19 Module on the National Healthcare Safety Network (NHSN). The changes impact the Resident Impact and Facility Capacity (form and instructions) and the Staff and Personnel Impact (form and instructions) pathways. These are being implemented this week and impact how positive test results are categorized and how COVID-19 deaths are reported, among other changes. An article by LeadingAge National provides an excellent preview of the changes.

Nursing Home Infection Control

LeadingAge National has learned from the Department of Health and Human Services (HHS) that the second part of Nursing Home Infection Control Quality Incentive Payments (QIP) related to the September performance period will be distributed on Nov. 30th. Providers received the first part on Nov. 2nd. The payments slated for next week will distribute $80 million to 8,925 nursing homes nationwide. The delay of these payments was related to data work that HHS needed to perform related to measuring COVID-19 mortality, which has prompted CMS to change that portion of the methodology.

With that change, HHS anticipates being able to distribute payments for the October performance period more quickly. HHS has observed a greater increase in community COVID-19 spread in October than in nursing homes, which should mean a larger total distribution than the $333 million made for September performance. The distribution date for October performance payments is not yet known, but HHS has indicated that they would be sharing a list of QIP recipients.

Long Term Care Providers Undergoing OSHA Inspections

The Occupational Safety and Health Administration (OSHA) has been conducting inspections of nursing homes and assisted living facilities in New York State, and a common citation is a violation of the respiratory protection standard. OSHA published respiratory protection guidance last month targeted at long term care facilities during the COVID-19 pandemic. The guidance notes that "[w]henever respirators are required, employers must implement a written, worksite-specific respiratory protection program (RPP), including medical evaluation, fit testing, training, and other elements, as specified in OSHA’s Respiratory Protection standard." Although OSHA has temporarily allowed for some enforcement flexibility regarding respirators, in order for OSHA to exercise enforcement discretion, employers must demonstrate and document good-faith efforts to comply with OSHA standards, as described in various OSHA guidance documents.

NYC Launches Emergency Surge Staffing Technical Assistance Program

The NYC Department of Health and Mental Hygiene (DOHMH) is launching a new emergency management initiative, the Emergency Surge Staffing Technical Assistance Program. The goal of the program is to help NYC’s nursing homes to maintain adequate staffing in the event of increased absenteeism due to illness or increased staffing needs resulting from medical surge.

The program includes a new planning tool, the Pandemic Surge Staffing Functional Annex; a webinar workshop that will introduce the Annex; and a virtual technical assistance session that will assist facilities in customizing the Annex to meet their specific circumstances. NYC DOHMH will be hosting a workshop on Wed., Dec. 2nd from 10 a.m. to 12 p.m. Nursing homes in NYC may register here.

Home and Community-Based Services (HCBS) Updates

Antigen Tests Are Acceptable Forms of COVID-19 Testing for Home Care and Hospice Providers Working in Nursing Homes and ACFs

Guidance issued by DOH on Oct. 19th clarifies the recommended uses of antigen tests for COVID-19 and the circumstances in which confirmatory PCR testing must be conducted. The guidance documents, which include an Interim Recommendations memorandum, Frequently Asked Questions (FAQs), and a confirmatory testing algorithm, indicate that antigen tests may be used to test individuals when there is an outbreak in a public setting or environment and to test residents and employees in nursing homes, ACFs, and other congregate facilities regardless of outbreak status.

Home care and hospice providers delivering care in facilities may also utilize antigen tests to comply with the testing requirement. These agencies are now receiving antigen test supplies and are utilizing them for their workforce. To learn more about antigen testing and recommended confirmatory testing, please see a previous LeadingAge NY Intelligence article here.

DOH Guidance on In-Home COVID-19 Specimen Collection

DOH has issued guidance for home health agencies regarding Medicaid billing and reimbursement for COVID-19 in-home specimen collection. Click here for more information.

Affordable Housing/Independent Living Updates

HUD Reopens Applications for COVID-19 Relief Payments

On Nov. 23rd, the Department of Housing and Urban Development (HUD) announced the continued availability of supplemental funds for HUD-assisted Multifamily Housing providers responding to COVID-19. In July, HUD announced the initial request period for COVID-19 Supplemental Payments; the new HUD Notice establishes a second request window and updates the submission requirements. The filing deadline for Multifamily Housing owners is Dec. 11, 2020 for expenses incurred through Nov. 30th. Click here for more information from LeadingAge National.

HUD Issues Revised Electronic Signature Guidance

Last week, HUD provided additional information about recent revisions to its electronic signature guidance. HUD’s May 2020 guidance permitted (but did not require) Multifamily partners to use electronic signatures and electronic file transmission and retention. The revised Notice, dated Nov. 6th, replaces the earlier guidance and provides updates to two sections, including the eligible Multifamily Housing programs and access of Enterprise Income Verification (EIV) data by Independent Public Auditors. Click here for more information from LeadingAge National.