Oct. 27th 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 Oct. 26th, 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.
HHS Revises Provider Relief Reporting Guidelines
Last week, the Department of Health and Human Services (HHS) updated the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) Provider Relief Funding (PRF) reporting guidelines issued in September. Most notably, the new guidance includes a key change in how General Distribution funding can be applied to lost revenue. In the September guidance, HHS surprised many when it defined lost revenue as a comparison of 2020 net operating income to 2019 income. This recent update reverts the lost revenue definition back to the original understanding: relief funding can be used to cover lost revenue defined as 2019 patient care revenue compared to 2020 patient care revenue. This simplifies the calculation and increases how much relief funding a provider may allocate to the lost revenue portion.
Please note that PRF payments must still be used to cover uncompensated COVID-19-related expenses first. Remaining funding can be applied toward lost revenue. The policy statement is available here, the revised reporting guidance is here, and a fact sheet is here.
While the first report is not due until mid-February, members may want to become familiar with the reporting requirements to ensure that they are tracking and documenting expenses and lost revenue in an efficient and appropriate way for subsequent reporting.
Despite the recent clarifications, there remain a number of open questions. A free webinar discussing the issue titled “Demystifying Recent HHS Reporting: Your Questions Answered” will be presented by CliftonLarsonAllen on Oct. 29th from 3 to 4 p.m. (register here). LeadingAge NY is also developing educational sessions to assist members with this process.
Relief Fund Applications Accepted Through Nov. 6th
HHS is accepting applications for a Phase 3 General Distribution of CARES Act PRF funding until Nov. 6th. This $20 billion distribution will target providers that have not yet received PRF funding equal to 2 percent of their annual patient revenue, behavioral health providers, and new providers that opened in January through March 2020. Any remaining funding will be distributed to applicants with COVID-19-related losses not otherwise reimbursed. The list of eligible applicants (which HHS expanded last week) includes most health care providers without regard to whether they participate in the Medicare and/or Medicaid programs. Any provider that has received PRF funding or was eligible to apply for funding is eligible to apply, although whether and how much funding a provider can expect based on COVID-19 losses will not be known until all applications are considered.
The announcement is available here, and the application portal is here. A set of slides providing step-by-step instructions is available here, and a number of questions in the PRF Frequently Asked Questions (FAQ) compilation address this distribution. HHS will present an applicant webinar on Nov. 2nd at 3 p.m. (register here), and an archived, hour-long webcast that details eligibility and the application process can be accessed here.
COVID-19 Vaccine Distribution Plans
The Centers for Disease Control and Prevention (CDC) has announced that it is partnering with CVS and Walgreens to offer on-site COVID-19 vaccination services for residents and staff of long term care and congregate settings for older adults. At the same time, New York State has released a draft plan for vaccination administration that would offer long term care facility workers and residents vaccines in the first phase of distribution. Click here for more information.
Visitation Guidance Issued for COVID-19 Cluster Zones
On Oct. 23rd, DOH issued guidance restricting visitation in various types of congregate facilities that are located in red or orange zones designated as part of the Governor’s Cluster Action Initiative. The initiative focuses response in defined geographic areas, addressing COVID-19 transmission on a focused basis and preventing broader viral transmission that would result in widespread economic shutdowns. To learn more about the initiative, click here.
The guidance pertains to the following types of residential congregate facilities:
- Nursing homes
- Adult care facilities (ACFs) and adult homes
- Pediatric skilled nursing facilities
- Facilities for individuals with developmental disabilities (Office for People with Developmental Disabilities (OPWDD)-run, licensed, or regulated homes)
- Facilities for individuals affected by substance use (Office of Addiction Services and Supports (OASAS)-run, licensed, or regulated facilities)
- Facilities for individuals in receipt of mental health services (Office of Mental Health (OMH)-run, licensed, or regulated facilities)
- Residential treatment centers (Office of Child and Family Services (OCFS)-run, licensed, or regulated facilities)
- Juvenile justice facilities
- Correctional facilities
The guidance, which took effect at 3 p.m. on Oct. 25th, requires residential congregate facilities in red and orange zones to limit visitation as follows:
All visitation is suspended in residential congregate facilities located in red zones, except for in the following instances:
- compassionate care (including end-of-life/hospice situations);
- medically or clinically necessary (i.e., visitor is essential to the care of the patient);
- accompanying a minor in a pediatric facility;
- labor/delivery/post-partum care;
- necessary legal representatives; and
- essential companions to individuals with intellectual and/or developmental disabilities or with cognitive impairments, including dementia.
Visitation is suspended at a residential congregate facility in an orange zone if a staff member or resident in the facility has tested positive for COVID-19 in the last 14 days. The guidance provides for the same exceptions to the visitation suspension as those that apply in red zones.
The guidance also states that “[u]nless superseded by this guidance, all other state agency guidance and policies with respect to visitation remain in effect.” Thus, prior DOH guidance governing nursing home and ACF visitation coexist with this cluster guidance. As members are aware, under prior DOH visitation guidance, visitation is suspended in any facility statewide that has a positive COVID-19 case among staff or residents within the last 14 days. However, the prior statewide guidance does not provide any exemption from visitation restrictions for “essential companions” to individuals. It seems unlikely that DOH intended to authorize broader access to visitors in facilities in the red and orange zones than is allowed outside of those zones. LeadingAge NY is seeking clarification from DOH.
We understand that at least one local health department has sought to suspend visitation on a county-wide basis beyond the borders of the red zone. However, the DOH guidance document is intended to supersede local health department directives. It states: “This supersedes other local health department orders which may impact visitation in these zones.” In addition, Executive Order (EO) 202.1 (extended by EO 202.67) provides that “[a]ny guidance issued by the New York State Department of Health related to prevention and infection control of COVID-19 at nursing homes and adult care facilities, including but not limited to guidance on visitation, shall be effective immediately and shall supersede any prior conflicting guidance issued by the New York State Department of Health and any guidance issued by any local board of health, any local department of health, or any other political subdivision of the State related to the same subject.” LeadingAge NY has asked DOH to address this with the pertinent local health department.
This guidance does not affect visitation in yellow zones. To access cluster zone maps, click here.
DOH Clarifies Guidance on False Positive Antigen Tests and Work Exclusion
On an association call on Oct. 22nd, DOH responded to questions posed by LeadingAge NY related to the exclusion of staff from work in three different scenarios: after positive antigen tests, asymptomatic with community exposure, and presentation with common cold symptoms. Click here for more information.
Rapid Molecular COVID-19 Test Is Focus of New DOH Guidance
On Oct. 22nd, DOH issued new guidance regarding the uses of rapid molecular tests for COVID-19, such as the Abbott ID NOW. The guidance provides that rapid molecular tests, like rapid antigen tests, may be used to test individuals associated with nursing homes, assisted living facilities, and other congregate settings. However, like the rapid antigen tests, the molecular tests require proper interpretation, and confirmatory testing is required under certain circumstances. Click here for more information.
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.
New York Updates Travel Advisory List
LeadingAge NY has been tracking the COVID-19 Travel Advisory requiring people to quarantine if traveling to New York from certain states, with certain conditional exceptions for essential workers. On Oct. 27th, the Governor announced that California has been added to the list, which now includes a total of 41 states and territories. No states have been removed. It should be noted that Connecticut, Massachusetts, New Jersey, and Pennsylvania meet the threshold criteria established to be on the list; however, given the interconnectivity of those bordering states, it was not deemed to be feasible to have them added to the list. Rather, unnecessary travel between those areas is discouraged.
Click here for more information and an archived list of states as they have been added or removed.
PHHPC Issues Report on Lessons Learned from COVID-19
The New York State Public Health and Health Planning Council (PHHPC) recently published a report, “Shaping the Future Health System in NYS: Lessons from COVID,” summarizing panel discussions of PHHPC’s Health Planning and Public Health Committees held on Aug. 12th and Aug. 19th. The panels were comprised of primary care providers as well as patient-oriented integrated health systems. The goal of these panel discussions was to identify lessons for preparing for future health care crises and for shaping the future health system in New York State. The concerns and recommendations discussed are outlined in the full report.
The panel’s overall recommendations are as follows:
- Inclusion of primary care and local health departments when key decisions are made about planning for future emergency response and system redesign.
- Consistent and sustained financing policy, strategy, and mechanisms that promote “managed care” – i.e., a capitated approach that includes value-based payments to incentivize and reward integrated, cost-effective, patient-centered care across all providers in the health care system.
- A clear, consistent primary care strategy led by DOH senior leadership in a collaborative working relationship with primary care systems and providers.
- A significant investment in the public health infrastructure at all levels, including need for upfront funding for emergency response.
- Continued efforts to strengthen collaborative planning, utilize the Governor’s EO to assure health across all policies and age-friendly NY among state agencies, and promote collaborative planning with relevant community/local government partners to assure an effective and sustainable emergency response and a longer-term focus on social determinants of health in system redesign.
- Regulatory and administrative simplification to reduce unnecessary burden on providers.
- Support for regulatory and financing changes to more effectively utilize telehealth.
- Investment in innovative and affordable efforts to build workforce capacity.
Mental Health Resources
DOH, recognizing that providers and the people they serve are dealing with an inordinate amount of stress, reminds that OMH has made available a variety of free COVID-19 stress management resources on its website. Click here to access the resources.
Nursing Home Updates
Nursing Homes Conducting Point-of-Care Testing Must Report COVID-19 Results Through NHSN
HHS has revised prior guidance to require nursing home limited service labs that are conducting point-of-care COVID-19 tests to report results via the National Healthcare Safety Network (NHSN). Although the updated guidance is still dated June 4th, LeadingAge NY has been advised by LeadingAge National that it was modified last week. Click here for more information.
ACF/Assisted Living (AL) Updates
Abbott BinaxNOW Rapid Test Distribution Update
As we have previously reported, ACF/AL members that hold a limited service laboratory registration certificate should have received or will be soon receiving Abbott BinaxNOW rapid tests; click here for information from HHS. Some members report having the limited service laboratory registration certificate, but not having received a shipment. According to the HHS website, you can direct shipment issues or questions to ARDxUSGovernmentSupport@abbott.com.
Affordable Housing/Independent Living Updates
LeadingAge Survey: Cases, Isolation, Financial Strain in Affordable Senior Housing
On Oct. 21st, LeadingAge National released the results of an early October survey of the impact of COVID-19 on affordable senior housing members. Click here for more information on the findings.