Issue: April 8, 2020

Published on April 8, 2020

Articles in this issue:

NYSHFA/NYSCAL April 9th Town Hall from 11:00 am - 11:30 am

Author: Jackie Pappalardi and Lisa Volk* Published in Clinical & Quality

We are listening to your requests to receive information as quickly as possible.  To meet that request, NYSHFA-NYSCAL has set up weekly Town Hall Calls to provide you information on key topics as well as, to offer you an opportunity to get questions answered and/or receive clarification. The next Town Hall Meeting will be on Thursday April 9, 2020 from 11:00 am - 11:30 am. The agenda for the April 9th Town Hall Meeting is attached along with documents for Maureen McCarthy’s presentation. Call in number:  1-800-220-9875 Passcode: 14227658# 

NYSHFA/NYSCAL CONTACTS:

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

DOH Healthcare Provider COVID-19 Weekly Call

Author: Jackie Pappalardi and Lisa Volk* Published in Clinical & Quality

Please join the NYS Department of Health Thursday, April 9th at 1-2 PM for a COVID-19 update for healthcare providers. 

To accommodate the large number of participants, our webinar will be streaming via YouTube Live: 

https://coronavirus.health.ny.gov/weekly-healthcare-provider-update 

For audio only, please dial in:  1-844-512-2950 

NYSHFA/NYSCAL CONTACTS:

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15

CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week

Author: Jackie Pappalardi and Lisa Volk* Published in Clinical & Quality, Finance & Reimbursement

The Centers for Medicare & Medicaid Services (CMS) has delivered near $34 billion in the past week to the healthcare providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic.  

“Healthcare providers are making massive financial sacrifices to care for the influx of coronavirus patients,” said CMS Administrator Seema Verma. “Many are rightly complying with federal recommendations to delay non-essential elective surgeries to preserve capacity and personal protective equipment. They shouldn’t be penalized for doing the right thing. Amid a public health storm of unprecedented fury, these payments are helping providers and suppliers – so critical to defeating this terrible virus – stay afloat.”

The streamlined process implemented by CMS for COVID-19 has reduced processing times for a request of an accelerated or advance payment to between four to six days, down from the previous timeframe of three to four weeks.  In a little over a week, CMS has received over 25,000 requests from health care providers and suppliers for accelerated and advance payments and have already approved over 17,000 of those requests in the last week.  Prior to COVID-19, CMS had approved just over 100 total requests in the past five years, with most being tied to natural disasters such as hurricanes.

The payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners and durable medical equipment (DME) suppliers. While most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months.

The CMS Accelerated and Advance Payment Program is funded from the Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) trust funds, which are the same fund used to pay out Medicare claims each day. The advance and accelerated payments are a loan that providers must pay back. CMS will begin to apply claims payments to offset the accelerated/advance payments 120 days after disbursement. The majority of hospitals including inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals will have up to one year from the date the accelerated payment was made to repay the balance. All other Part A providers and Part B suppliers will have up to 210 days to complete repayment of accelerated and advance payments, respectively.

It is important to note, this funding is separate from the $100 billion provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act appropriation is a payment that does not need to be repaid. The Department of Health and Human Services (HHS) will be providing additional information on how healthcare providers and suppliers can access CARES Act funds in the coming weeks.

The fact sheet on the accelerated/advance payment process and how to submit a request can be found here: Fact Sheet Providers can also contact their Medicare Administrative Contractor for any questions.

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website. 

NYSHFA/NYSCAL CONTACTS:

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

Carl J. Pucci
Chief Financial Officer
518-462-4800 x36

AHCA: COVID-19 Update #34 - OSHA on PPE Shortages

Author: Jackie Pappalardi and Lisa Volk* Published in Clinical & Quality

In This COVID-19 Update:

OSHA Issues Memoranda on Respiratory Protection  

The Occupational Safety and Health Administration (OSHA) has issued two separate enforcement memoranda related to the use of respirators by healthcare and non-healthcare employers. This includes all long term care providers: skilled nursing, assisted living, and ID/DD providers. The memoranda address issues facing employers regarding the respirator shortage, giving employers limited relief from OSHA’s Respiratory Protection standard as a result from COVID-19.

The first memoranda gives employers relief to extend the use of National Institute for Occupational Safety and Health (NIOSH) – approved respirators and to permit reuse of them. The second memoranda allows employers in certain circumstances to use respirators approved by another country, where NIOSH-approved respirators are not available. Employers must exhaust all NIOSH-certified respirators prior to use non-NIOSH-certified respirators. You can read more details including the guidance on Littler’s website.  

Be Prepared - OSHA Requirements for PPE  

AHCA/NCAL has learned that some members and other health care entities are receiving letters from OSHA regarding lack of PPE. AHCA/NCAL has consulted with our outside consultants who recommend preparing a plan with the following information:   

  1. If you are running low on PPE, follow the CDC guidance and guidance from your local health department. 
  2. Have a plan in place that deals with potential exposure to COVID-19 for employees, for example, what happens if a staff member has respiratory or other symptoms indicative of COVID-19 or tests positive with COVID-19.  
  3. Communicate this plan to all staff often and have it available for staff to review.    

Recording workplace exposures to COVID-19 - Occupational Safety and Health Administration (OSHA)   

OSHA recordkeeping requirements at 29 CFR Part 1904 mandate covered employers record certain work-related injuries and illnesses on their OSHA 300 log. While these requirements exempt recording of the common cold or flu, COVID-19 is a recordable illness when a worker is infected on the job if the following are met:  

  1. Case is confirmed COVID-19  
  2. The case is work-related as defined by 29 CFR 1904.5 and  
  3. The case involves one or more of the general recording criteria set forth in 29 CFR 1904.7  

Visit OSHA’s Injury and Illness Recordkeeping and Reporting Requirements page for more information.  

Payroll Based Journal Update 

CMS is waiving 42 CFR 483.70(q) to provide relief to long-term care facilities on the requirements for submitting staffing data through the Payroll-Based Journal system. This means that staffing data for the first quarter of 2020 (1/1/20 – 3/31/20) will not need to be submitted for the May 15, 2020 deadline, nor will this data need to be submitted later.

At present, there is no additional information as to how long this waiver will remain in place and providers should continue to collect staffing data, as CMS has only waived submission of data but not the collection of the data. 

CMS Call Thursday, April 9th - CMS “Office Hours” on COVID-19 

Opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to: 

Submit questions in advance to partnership@cms.hhs.gov, including “Office Hours” in the subject line. There will also be live Q&A. Conference lines are limited, so it is highly encouraged you to join via audio webcast, either on your computer or smartphone web browser.  

Thursday, April 9th 
5:00 – 6:00 PM EDT

Attendee Dial In: 833-614-0820 
Event Plus Passcode: 1881716 
Join via Audio Webcast

FAQs on the Payroll Protection Program 

The Department of the Treasury released a new FAQ this week that clarifies certain areas of the Paycheck Protection Program created by the Coronavirus Aid, Relief and Economic Security Act (CARES Act). Among other topics, the FAQ specifies that the $100,000 cap on payroll costs used to calculate the PPP loan size applies to salary costs only. This means that a wider range of employees can be factored into the loan size calculation than originally believed, since healthcare benefits, retirement benefits and other compensation do not need to be factored into the cap.

The full FAQ can be found here
 
HUD COVID-19 Relief

AHCA/NCAL has received confirmation from the U.S. Department of Housing and Urban Development (HUD) that in response to recommendations from the industry, HUD review and approval of the below types of transactions for Section 232 insured facilities impacted by COVID-19 is not required. If the Lender has been notified that the project is with the Risk Mitigation Branch, then HUD approval is required. This is effective through July 31, 2020 and applies to the following: 

  1. Suspend monthly deposits to the replacement reserve through July 31, 2020, at which time the deposits will resume unless HUD grants a further extension. At the conclusion of the suspension period, the sum of the suspended payments shall be paid into the Reserves for Replacement in equal monthly increments over the next 12 consecutive months. 
  2. Use operating deficit funds to meet debt service payments, subject to repayment provisions, if any, contained in the subject escrow agreement. 
  3. Use debt service reserves to meet debt service payments; subject to repayment provisions, if any, contained in the subject escrow agreement. 
  4. Use replacement reserve accounts to meet debt service payment requirements so long as the account balance does not fall below $1,000 per unit. 

To exercise this authority, borrowers must demonstrate, to the lender’s satisfaction, that their request results from the impacts of COVID-19. While HUD approval will not be required, the lender is expected to report any utilization of the above to their assigned account executive and discuss any new risks at the facility that have may have emerged.

On a case-by-case basis, HUD will consider requests from borrowers for other non-conventional uses of escrow funds. Balances in these accounts are typically not significantly larger than the projected amounts needed for those accounts’ intended purposes. Moreover, the balances are not likely substantial enough to significantly offset COVID-19 operating revenue and expense impacts. 

For further detail see HUD’s frequently updated COVID-19 FAQ

Please email COVID19@ahca.org for additional questions, or visit ahcancal.org/coronavirus for more information.

NYSHFA/NYSCAL CONTACTS:

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15