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Nov. 3rd COVID-19 Update

New COVID-19-related updates for providers of long-term/post-acute care (LTPAC) and senior services continue to be shared on a regular basis by both state and federal authorities. The latest developments are described 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. 2nd, 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

Last Call for Phase 3 Provider Relief Funding

A reminder that Nov. 6th marks the deadline to apply for a Phase 3 General Distribution of Coronavirus Aid, Relief, and Economic Security Act (CARES Act) Provider Relief Funding (PRF). Any provider that has received or was eligible to receive funding in any prior distribution may apply. After ensuring that all applicants have received 2 percent of their annual patient revenue in PRF funding, the Department of Health and Human Services (HHS) will use the remainder of the $20 billion allocation to target providers with lost revenue and/or increased expenses related to the pandemic. HHS intends to develop the methodology for distributing this funding after reviewing the applications. Early indications suggested that application volume was low.

The announcement is available here, and the application portal is here. Application instructions are available under the heading “How to Apply for Phase 3 General Distribution” on the PRF Provider page here, and a number of questions in the PRF Frequently Asked Questions (FAQ) compilation address this distribution. An archived, hour-long webcast that details eligibility and the application process can be accessed here. Although the prospect and magnitude of funding is not known, members with uncompensated financial impacts of COVID-19 are encouraged to apply.

HHS has also advised that most of the Phase 2 General Distribution funding has been distributed or is currently being processed. Providers that applied under Phase 2 and have not heard anything should apply for Phase 3 funding or can call the PRF support line to check on the status of their application (866-569-3522).

PRF Reporting Changes

As reported last week, HHS continues to refine and clarify the permissible uses of CARES Act PRF funding and related accounting requirements by updating reporting guidelines for those who receive funding and issuing a number of FAQs. While members should be aware of the requirements to ensure that they are tracking and documenting financial impacts in the most appropriate way, it is important to note that further changes are likely in upcoming clarifications. We are working to arrange educational opportunities for members and expect several sessions between now and the Feb. 15th due date for the first report.

County Positivity Rates

The most recent listing of 14-day testing positivity rates for each county in New York State from the Centers for Medicare and Medicaid Services (CMS) is available here. Current daily county-level data for New York State are here, and ZIP-code level data for New York City showing infection rates during the most recent four weeks are available here.

State Develops Testing Strategy for Travel Advisory

Given the number of states and territories that have been added to the travel advisory list, the State is taking a new direction. According to an Oct. 31st press release from the Governor, rather than maintaining a quarantine list of states and territories, the State has developed a testing strategy, which will be effective Nov. 4th. It should be noted that, as had been the case prior, “essential workers” are exempt from this policy and should be following guidance regarding the conditions under which they can return to work. Thus, members should continue to follow the existing guidance regarding the travel advisory as it relates to their setting and essential workers. Additionally, travel between New York and the contiguous states is exempt from the policy. Click here for details.

More Details on NYC, State, and Federal COVID-19 Vaccination Programs

COVID-19 vaccination plans are currently being rolled out by the federal, state, and New York City (NYC) government. We now have more information on all programs to share, which builds upon the update we shared on Oct. 30th. It is important to note that a COVID-19 vaccine is not yet available, and these plans are being put into place to help mobilize vaccinations to priority populations once available. The details of these plans may change. Click here for more details.

CMS Issues Rule on COVID-19 Vaccine Coverage, Cost, and Other Public Health Emergency Provisions

On Oct. 28th, CMS issued an interim rule, open for comment, regarding COVID-19 vaccine coverage, cost, and other public health emergency provisions. The rule:

  • Creates flexibilities for states maintaining Medicaid enrollment during the COVID?19 Public Health Emergency (PHE);
  • Establishes enhanced Medicare payments for new COVID-19 treatments;
  • Addresses price transparency for COVID-19;
  • Extends Performance Year 5 for the Comprehensive Care for Joint Replacement (CJR) model to provide “relief and stability in model operation” amid the PHE; and
  • Creates flexibilities in the public notice requirements and post-award public participation requirements for a State Innovation Waiver under Section 1332 of the Patient Protection and Affordable Care Act during the COVID-19 PHE.

CMS is also issuing three toolkits aimed at state Medicaid agencies, providers who will administer the vaccine, and health insurance plans to address issues related to access, billing and payment, and coverage.

The toolkits give health care providers not currently enrolled in Medicare the information needed to administer and bill vaccines to Medicare patients. New providers are now able to enroll as “Medicare mass immunizers” through an expedited 24-hour process.

Nursing Home Updates

DOH Addresses Questions on Micro-Cluster Visitation and Visits by External Health Care Professionals

In a weekly call with nursing home association representatives on Oct. 29th, staff from the Department of Health (DOH) and the Governor's Office addressed several questions related to visitation and offered infection prevention recommendations. Click here for more information about the call.

POC Test Result Reporting Requirement

As detailed in an article in last week’s Intelligence, nursing homes that are conducting point-of-care (POC) COVID-19 tests are now required to report results via the National Healthcare Safety Network (NHSN). The Centers for Disease Control and Prevention (CDC) has scheduled two reporting training webinars for this week: one on Thurs., Nov. 5th at 12:30 p.m., and one on Fri., Nov. 6th at 11:30 a.m. Registration is required, space is limited, and early sign-on is recommended. Registration for both events is available here, the reporting form is here, and form instructions are here.

Please note that to comply with these requirements, nursing homes must have NHSN Level 3 security. Homes needing to upgrade to Level 3 should email NHSN@cdc.gov with “Enhancing Data Security” in the subject line. Although the requirement may eventually simplify reporting, until further guidance is provided by DOH, nursing homes must continue to report results through New York State's Electronic Clinical Laboratory Reporting System (ECLRS) as well. LeadingAge NY has contacted Wadsworth Labs about the burden of the duplicative requirements, and LeadingAge National is advocating for streamlined data upload instead of the current manual entry process.

HHS Issues Infection Control Incentive Program Payments

HHS issued the first round of infection control quality incentive program payments to nursing homes on Mon., Nov. 2nd. Homes whose COVID-19 infection rates in September were lower than their overall county infection rates and whose mortality rates (risk-adjusted for demographics) were below 10 percent qualified for a payment.

To calculate the size of the payment, HHS compared a facility’s observed count of infections (acquired in the nursing home) to the expected number of infections based on the overall infection rate in their county and the total number of resident weeks accrued in the performance period. This comparison yields each facility’s infection control score in a given performance period, which is multiplied by a specified “benchmark infection payment rate” to arrive at the infection control payment. This payment is further adjusted by a mortality rate adjustment.

For New York State, the resulting payments are modest, ranging between $500 and $30,000. Based on preliminary HHS figures, 443 facilities in New York are receiving a portion of the $7.1 million statewide total. Those numbers suggest an average facility payment of about $16,000. We continue to analyze the distribution formulas to get a fuller understanding of the methodology, although the lack of some key figures such as the community infection rates used in the calculation make it difficult to validate the distribution amounts. Members who believe that they should have qualified for a payment based on the criteria listed above but have not received one are asked to notify Darius Kirstein at dkirstein@leadingageny.org.

CMS Unveils New Online Nursing Home Resource Center

On Oct. 30th, CMS launched a new online platform – the Nursing Home Resource Center – to serve as a centralized hub bringing together the latest information, guidance, and data on nursing homes relevant to providers, residents, and their families, especially as the fight against COVID-19 continues. Click here for more information.

Home and Community-Based Services (HCBS) Updates

DOH Issues Guidance for 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

Service Coordinators: Relief Funds, Renewals, and Reporting Deadlines

On an Oct. 26th call with LeadingAge affordable housing provider members, Katina Washington, acting branch chief for grants and new funding at the Department of Housing and Urban Development (HUD) Office of Asset Management and Portfolio Oversight, gave an update on current Service Coordinator issues. Juliana Bilowich, director of housing operations and policy at LeadingAge, facilitated the lively discussion. Click here for more information on the call.