Issue: April 23, 2020

Published on April 23, 2020

Articles in this issue:

CLARIFICATION: COVID-19 Update #47 | Additional Distribution of Provider Relief Funds

Author: Lisa Volk and Carl Pucci* Published in Clinical & Quality, Finance & Reimbursement

This is a clarification from yesterday’s member mailing on AHCA’s Update #47 regarding Additional Distribution of Provider Relief Funds:

Two weeks ago, we learned that skilled nursing would be included as part of the stimulus bill’s (aka the CARES Act) $100 billion Provider Relief Fund, when HHS distributed the first $30 billion from the fund and all skilled nursing facilities received 6.2% of their 2019 Part A and Part B Medicare payments. Today, HHS announced an additional $40 billion in distributions, with checks going out as early as this Friday. Here is what we know so far.  

  1. SNFs are clearly part of a tranche of funds that HHS is using to pay providers based on their total revenue. It will distribute $20 billion of the $40 billion based on a percentage of providers total revenue, but will make some adjustment for Medicare revenue, that was recognized in the prior payment. We do not know the exact formula yet, but providers who have a high level of Medicaid and/or Medicare Advantage, will do proportionally better than those who do not. 
  2. HHS is also distributing $10 billion to those in COVID-19 hotspots. This may be for hospitals only. We are verifying that and if we are not part of these funds, we will seek reimbursement for SNF and AL COVID hotspots in future funding. 
  3. HHS is also distributing $10 billion to rural hospitals.   

The additional news is that tomorrow Congress will likely add $75 billion to this fund. That will replenish the fund to slightly over $100 billion. We will work to continue to receive the funding you deserve as you fight the daily battles in your buildings. As we learn more about the formula utilized to distribute the $20 billion, we will let you know.

NYSHFA/NYSCAL CONTACTS:

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

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

Provider Relief Funds – Updated FAQs

Author: Carl J. Pucci* Published in Finance & Reimbursement

AHCA/NCAL’s FAQs on the Provider Relief Fund has been updated to include information on the additional funding to be released this week. AHCA will continue to update the FAQ, as an increase of $75 billion is expected to pass the House and be signed by the President today.

Questions should be sent to COVID19@ahca.org.

NYSHFA/NYSCAL CONTACTS:

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

CMS Request for Best Practices in Response to COVID-19

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

We have received a request from CMS asking us to collate state-specific information on actions undertaken and best practices identified related to nursing homes in response to the COVID-19 pandemic. These can be policy or payment driven actions or best practices created in response to the pandemic for nursing homes. Any providers interested in sharing best practices, as well as be potentially showcased on the CMS calls, please reach out to Jackie Pappalardi or Lisa Volk. 

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

AHCA: COVID-19 Update #48 | Preparing for Widespread Testing

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

In This COVID-19 Update:

Preparing for Widespread Testing 

The Centers for Medicare and Medicaid Services (CMS) has recently emphasized the importance of testing for COVID-19 in nursing facilities. In addition, a growing number of states are requiring testing of all residents and/or staff. When accessing testing, we recommend providers ensure that the tests are FDA approved PCR tests (versus Antibody/Serology tests) and that the lab will bill Medicare directly. Providers need to have a plan in place to isolate residents who test positive, and follow CDC guidance for staff that test positive. More information and guidance on preparing for widespread testing is available in here

Documentation 

Law firm Husch Blackwell lays out some general steps for documenting activities and response efforts to be prepared for surveys and potential litigation.  AHCA/NCAL also recommends working with your legal counsel to develop practices. This resource is available to AHCA/NCAL members (log in required). 

Scammers Posing as Government Officials  

AHCA/NCAL has developed a resource to warn providers about potential scammers posing as government officials. Learn more about how to screen callers claiming to be representing a state or federal agency or official or claiming to be from the IRS, Department of Commerce, or a Bank or other financial institution without first verifying the caller’s identity. This resource also includes ways to protect residents from scammers and some safety tips to confirm legitimate outreach calls from CMS or the CDC.  

Separately, AHCA/NCAL had previously created a resource on how to beware of scams when working with vendors offering personal protective equipment. 

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: COVID-19 Guidance for Voluntary Personal Care Services Plan of Care Changes

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

Please see the attached, issued April 23, 2020 by the Department of Health, regarding COVID-19 Guidance for Voluntary Personal Care Services Plan of Care Changes.

This guidance will also be posted on the COVID-19 Guidance for Medicaid Providers webpage, which is updated regularly with guidance and information.

Questions regarding this guidance may be sent to MLTCinfo@health.ny.gov

Thank you. 

Medicaid Redesign Team Updates
Office of Health Insurance Programs
New York State Department of Health
Albany, NY 12237
mrtupdates@health.ny.gov


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 NEWS ALERT: April 23, 2020 (COVID-19)

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

Here is a summary of recent Centers for Medicare & Medicaid Services (CMS) actions taken in response to the 2019 Novel Coronavirus (COVID-19), as part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, click here www.coronavirus.gov. For information specific to CMS, please visit the CMS News Room and Current Emergencies Website. CMS updates these resources on an ongoing basis throughout the day; the information below is current as of April 23, 2020 at 10:00 a.m.

CMS Issues Guidance Allowing Independent Freestanding Emergency Departments to Provide Care to Medicare and Medicaid Beneficiaries during the COVID-19 Public Health Emergency

CMS issued critical guidance allowing licensed, independent freestanding emergency departments (IFEDs) in Colorado, Delaware, Rhode Island, and Texas to temporarily provide care to Medicare and Medicaid patients to address any surge resulting from COVID-19. This action by the Trump Administration increases hospital capacity to ensure these states can quickly and effectively care for their most vulnerable citizens. Current law does not recognize IFEDs as a certified Medicare provider, meaning they cannot bill Medicare and Medicaid for services. However, during this public health emergency, these entities can be temporarily certified as a hospital to increase healthcare system capacity as part of each state’s pandemic plan.

Press Release

Trump Administration Launches New Toolkit to Help States Navigate COVID-19 Health Workforce Challenges

CMS and the Assistant Secretary of Preparedness and Response (ASPR) released a new toolkit to help state and local healthcare decision makers maximize workforce flexibilities when confronting COVID-19 in their communities. Developed by the Healthcare Resilience Task Force as part of the unified government’s response to COVID-19, the toolkit includes a full suite of available resources such as information on funding flexibilities, liability protections, and workforce training, to maximize responsiveness based on state and local needs. For example, state and local communities will be able to see how and where workforce waivers can be applied based on information from other areas. The resource builds on the Trump Administration’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

Press Release

Toolkit

Compliance Flexibilities Announced for Implementation of Interoperability Final Rules Due to COVID-19

In response to the COVID-19 public health emergency, CMS and the Office of the National Coordinator for Health IT (ONC), in conjunction with the HHS Office of Inspector General (OIG), announced a policy of enforcement discretion to allow compliance flexibilities regarding the implementation of the interoperability final rules announced on March 9, 2020. ONC, CMS, and OIG will continue to monitor the implementation landscape to determine if further action is needed.

Press Release

Updated Guidance Available for Plan Issuers on Prior Authorization, CARES Act Implementation

CMS issued guidance to issuers of individual, small group, Medicare Advantage, and Part D plans, addressing the flexibilities available related to utilization management and prior authorization during the COVID-19 public health emergency. New guidance for individual and small group health plans encourages issuers to utilize flexibilities related to utilization management processes, as permitted by state law, to ensure that staff at hospitals, clinics, and pharmacies can focus on care delivery and ensure that patients do not experience care delays.

Updated guidance for Medicare Advantage and Part D plans allows them to implement a number of additional flexibilities to support efforts that can help curb the spread of the virus and to help ensure MA and Part D enrollees do not experience disruptions in care or disruptions in pharmacy and prescription drug access. The guidance also implements important provisions of the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security (CARES) Act regarding coverage for COVID-19 testing and testing related services.

Individual and Small Group Plan Guidance

Medicare Advantage and Part D Plan Guidance

CMS Releases Additional Waivers for Long-Term Care Hospitals, Rural Health Clinics, Federally Qualified Health Centers and Intermediate Care Facilities

CMS continues to release waivers for the healthcare community that provide the flexibilities needed to take care of patients during the COVID-19 public health emergency. CMS recently provided additional blanket waivers related to caring for patients in Long-Term Care Hospitals (LTCHs), temporary expansion locations of Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), staffing and training modifications in Intermediate Care Facilities for individuals with intellectual disabilities, and the limit for substitute billing arrangements (locum tenens).

Guidance

CMS Gives States Additional Flexibility to Address Coronavirus Pandemic

CMS approved its first Medicaid COVID-19 emergency demonstration, making the state of Washington the first to receive approval. The approval provides new flexibility and resources so the state of Washington can deliver the most effective care to their Medicaid beneficiaries. In addition to new payment and reimbursement arrangements, the demonstration allows the state to target services based on geography and population needs and to triage access to long-term services and supports (LTSS) based on highest need.

To date, CMS has approved more than 115 requests for state relief in response to the COVID-19 pandemic, including recent approvals for Colorado, New York, Ohio, South Carolina, Washington, Wyoming, and Puerto Rico. These approvals help to ensure that states have the tools they need to combat COVID-19 through a wide variety of waivers, amendments, and Medicaid state plan flexibilities, including for programs that care for the elderly and people with disabilities. CMS developed a toolkit to expedite the application and review of each request and has approved these requests in record time. These approved flexibilities support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported.

Section 1135 Waivers

Section 1115(a) Waivers

1915(c) Waiver Appendix K Amendments

Medicaid State Plan Amendments

CHIP State Plan Amendments

NYSHFA/NYSCAL CONTACTS:

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

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

AHCA/NCAL Social Media Update

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

Welcome to the AHCA/NCAL Social Media Update. We are currently using this newsletter to activate our social media advocates to share our resources related to COVID-19. Because of the urgent public health nature of this disease, these are resources for all providers, not just AHCA/NCAL members, so we hope you can help us promote them in channels other than direct member communications.

For positive stories related to providers responding to COVID-19 and keeping patients and residents safe, please look for our new Provider Daily Special Edition, which goes out every Tuesday and Thursday.

If you have an interested colleague or a suggestion for what to share on social media, please have them send an email at socialmedia@ahca.org so they can join in.

Content To Share on Social Media

Prioritizing Long Term Care

The below stories showcase the importance of ensuring LTC providers have all necessary resources to combat the spread of coronavirus. 

Long term care providers have been ignored when it comes to #PPE and testing. “The real battle is taking place in nursing homes, we should be at a priority level one.” https://www.usnews.com/news/politics/articles/2020-04-23/weve-been-ignored-nursing-homes-plead-for-more-testing

Long term care providers are STILL struggling to source and afford #PPE and testing. These resources are absolutely crucial in these settings if our nation is going to contain this disease. https://www.cnn.com/2020/04/21/politics/nursing-homes-supplies-testing/index.html

3 steps to save lives: prioritize long term care centers for #PPE, give them sufficent tests for staff/residents, and coordinate hospital discharges. It’s time for lawmakers to concentrate where it matters. https://www.foxnews.com/opinion/coronavirus-nursing-homes-trump-help-3-ways-dr-richard-feifer

Immediate long term care needs: #PPE, testing, staff funds. These providers are the front line of the #COVID19 fight and have been ignored. It’s time for policymakers to make LTC the top priority. https://www.bostonglobe.com/2020/04/17/opinion/how-reduce-coronavirus-deaths-nursing-homes/

Not only have long term care provides been ignored, senior living has yet to receive any direct portion of the CARES Act or other financial aid. Some of the most vulnerable individuals are put at risk if our senior care communities aren’t supported. https://www.mcknightsseniorliving.com/home/news/hhs-states-should-support-senior-living-through-955-million-in-cares-act-grants-announced-tuesday-group-says/

Honoring #LTCHeroes

We are honoring and sharing the courage and dedication of long term care workers by sharing positive stories and using the hashtag #LTCHeroes 

A must read for everybody: testimony from a long term care nurse about the courage of the caregivers around her and how to respond to the negativity surrounding the profession. #LTCHeroes https://www.sun-sentinel.com/opinion/commentary/fl-op-com-hunt-nursing-homes-nurses-heroes-20200422-wqrpiwyfrfhy5cawuvvlcwog2q-story.html

Tammy Hunt, a registered nurse in long term care for over 12 years: “do your part to lift us up, not tear us down. Everyone I work with is a hero on the frontline, and they deserve your support.” #LTCHeroes https://www.sun-sentinel.com/opinion/commentary/fl-op-com-hunt-nursing-homes-nurses-heroes-20200422-wqrpiwyfrfhy5cawuvvlcwog2q-story.html

We need to honor long term care workers and treat them the same way the country treats hospitals & staff. #LTCHeroes are on the front line of combatting #COVID19 and deserve all the support and resources. https://thehill.com/opinion/healthcare/493087-lets-help-frontline-heroes-of-senior-care-facilities

"It breaks my heart to know how lonely and scared some of my residents are. I long for the day when I can hug everyone one of them again." In the same way, let's give hugs and not hurt to our frontline heroes in senior care. #LTCHeroes https://thehill.com/opinion/healthcare/493087-lets-help-frontline-heroes-of-senior-care-facilities

It’s time to honor “nurses, aides, cleaning staff, dietary staff, therapists, social workers and administrative staff who have been working so hard to keep their vulnerable residents safe from COVID-19" #LTC Heroes https://www.pressconnects.com/story/news/local/2020/04/23/coronavirus-ny-nursing-homes-binghamton-families-visitation/3002819001/

NYSHFA/NYSCAL CONTACTS:

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

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