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COVID-19 Updates: May 14, 2020
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This update includes:
- Wisconsin Supreme Court Strikes Down "Safer at Home" Order - CMS Directive on Visitation Still in Effect for Nursing Homes; Awaiting Guidance on ALs
- Gov Evers Offers Remarks on Visitation in LTC Settings During COVID-19 Press Conference
- N95 Decontamination System Up and Running
- CMS issues Emergency Declaration 1135 Blanket Waivers to Expand Hospitals’ Abilities to Offer Long-Term Care Services, Swing Beds
- Launch of Updated & Expanded Version of AHCA’s Infection Preventionist Training (IPCO)
- Bureau of Assisted Living Regulatory Response to COVID-19 – Assisted Living Forum Tuesday, May 19, 2020
- Stimulus Checks Do Not Affect Medicaid Eligibility
- WHCA/WiCAL Supports the Strengthening Innovation in Medicare and Medicaid Act
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As of today, there are 11,275 confirmed cases of COVID-19 in the state of Wisconsin and 434 deaths caused by the virus. Click
HERE
to view the latest outbreak information from the Wisconsin Department of Health Services. Click
HERE
to view COVID-19 projections for Wisconsin and the United States.
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Wisconsin Supreme Court Strikes Down "Safer at Home" Order - CMS Directive on Visitation Still in Effect for Nursing Homes; Awaiting Guidance on ALs
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On the evening of Wednesday, March 13, the Wisconsin Supreme Court
issued an opinion which struck down
Emergency Order 28, an Order which had extended Wisconsin's original stay-at-home order from April 24 to May 26. The conservative Court voted 4-3 to overturn the Order.
For nursing homes, a
CMS directive to restrict visitation is still active. The state survey agency has indicated it will continue to rely on this memo for Infection Control survey activity.
Survey activity will still remain limited under this
CMS memo.
DHS guidance continues to
recommend visitation restrictions for all LTC settings, as well as screening residents/staff regularly, practicing social distancing, and restricting communal dining.
WHCA/WiCAL has created three documents (
available here) to help notify residents, families, and staff that current visitation restrictions remain in place in Wisconsin nursing homes:
- Template letter – notification to families that the CMS visitation restriction memo is still active
- Template door posting – notification that visitation restrictions remain in effect
- Template communication to staff encouraging the use of caution and social responsibility
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Please note:
WHCA/WiCAL has reached out to DQA - Bureau of Assisted Living officials for more information on how the state plans to proceed with Assisted Living visitation restrictions.
DQA officials have indicated an announcement on ALF guidance tomorrow, Friday, May 15. The above information is specifically oriented toward nursing facilities, and WHCA/WiCAL will provide information for AL facilities as soon as it becomes available.
In the interim, WHCA/WiCAL reminds assisted living operators that
CDC guidance
recommends all LTC settings restrict visitation to prevent the spread of COVID-19.
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Gov Evers Offers Remarks on Visitation in LTC Settings During COVID-19 Press Conference
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Today during a regular press conference on the state's response to COVID-19, Gov. Tony Evers discussed the Supreme Court's decision to overturn the state's Safer-at-Home order, and in particular how it affects a state-level requirement to prohibit visitation to long-term care facilities in order to reduce the spread of COVID-19. The Governor said:
"This pandemic hasn’t gone away, and the threat to frail older adults remains real and potentially dangerous. The Department of Health Services and the provider community are working hard to develop options and strategies to allow visitations to safely occur under certain circumstances and conditions. We all want visitations to occur and open up, but we don’t want to thoughtlessly threaten the lives of older adults. I know that folks are eager to visit their loved ones, and I understand that. I appreciate your patience and understanding as we all try and make sense of this situation and find solutions that will keep your loved ones safe."
The governor's remarks deviate from previously stated policy, in which a
supplemental "Badger Bounce Back" document stated that visitation to long-term care facilities can resume once a vaccine is available (see grid on p. 5).
WHCA/WiCAL has been working with providers and other associations to discuss what a workable alternative to the "Bounce Back" document may look like, and the governor's words today are encouraging that facilities will not necessarily be expected to wait as long as 18 months (until a vaccine is available) to resume visitation in some form.
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N95 Decontamination System Up and Running
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Wisconsin’s new Battelle Memorial Institute Critical Care Decontamination System™ (CCDS) is now ready and available for use by the state’s health care workers and first responders for decontamination of their N95 respirators. The Battelle CCDS™ decontaminates N95 respirators by killing viruses and bacteria using hydrogen peroxide gas.
The Battelle system will be able to decontaminate up to 80,000 N95 respirators on a daily basis. Battelle advises that its system can decontaminate respirators up to 20 times without degrading filtration performance. The usual decontamination turnaround time for users is a maximum of 72 hours, plus shipping time, as long as the site is not over its capacity for use.
Decontamination services, including shipping, will be provided to Wisconsin health care organizations and professionals free of charge. Eligible health care providers include, but are not limited to, hospitals, nursing homes, public health professionals, human and child protective services offices, emergency managers, first responders, coroners, medical examiners, law enforcement and correctional institutions, home health organizations, pharmacists, rural health services and dental offices.
Health care workers and first responders, please save and send in your used PPE supplies for decontamination.
The Battelle system can only decontaminate respirators, and not other items of PPE. It is also not authorized for use with respirators containing cellulose-based materials. UV decontamination sites, which can service N95 respirators as well as other types of PPE, are already in place in much of Wisconsin.
- All compatible N95 respirators must be free of any visual soiling or contamination (e.g., blood, bodily fluids, makeup).
- Compatible N95 respirators that are visually soiled or damaged should not be collected for decontamination and will be disposed of and not returned after decontamination.
- Masks should be marked with the name of the healthcare professional to whom the mask was issued.
How to initiate Battelle N95 Decontamination:
Note: Each row of data in the excel sheet should be for a physical location at which you would like to send and receive masks. Example a countywide fire department would want to put in a line for each firehouse so each can send and receive masks directly.
Step 3: 3-digit site codes for each location will be provided to you after the services agreement is executed. The 3-digit codes are to be marked on each N95 respirator you collect. Begin collecting and labeling your N95 respirators. Each N95 respirator must be handled and labeled properly to be decontaminated. Below are specific instructions for details on how to collect, label, and package your respirators for shipment.
- Instructions for Healthcare Personnel (mask marking) [pdf]
- Instructions for Healthcare Facilities [pdf]
- HCP - Fact Sheet [pdf]
It is VERY IMPORTANT that every N95 is properly labeled and free of any visible soiling such as blood, bodily fluids, and makeup. They cannot decontaminate N95s that do not meet these requirements.
Step 4: SEND RESPIRATORS! When you prepare to send your N95s, you will need to download and fill out the
Chain of Custody Form [xlsx]. Please provide one form per shipment.
About Wisconsin’s Battelle System:
Through a partnership with the Federal Emergency Management Agency (FEMA) and Defense Logistics Agency (DLA), the State of Wisconsin received the Battelle system earlier this week. This system is being provided without costs to Wisconsin’s health care workers and first responders through a federal grant. No state tax dollars are involved to supplement the costs.
Resources:
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CMS issues Emergency Declaration 1135 Blanket Waivers to Expand Hospitals’ Abilities to Offer Long-Term Care Services, Swing Beds
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The Center for Medicare & Medicaid Services (CMS) continues to release
1135 Blanket Waivers for the healthcare community that provide the flexibilities needed to take care of patients during the COVID-19 Public Health Emergency (PHE). CMS recently provided additional blanket waivers for the duration of the PHE that expand the ability for hospitals to offer long-term care services (“Swing-Beds”) for patients who do not require acute care but do meet the Skilled Nursing Facility (SNF) level of care criteria as set forth at 42 CFR 409.31. (
New since 4/30 Release)
Under section 1135(b) (1) of the Act, CMS is waiving the requirements at 42 CFR 482.58,
“Special Requirements for hospital providers of long-term care services (“swing-beds”)” subsections (a)(1)-(4)
“Eligibility”, to allow hospitals to establish SNF swing beds payable under the SNF prospective payment system (PPS) to provide additional options for hospitals with patients who no longer require acute care but are unable to find placement in a SNF.
In order to qualify for this waiver, hospitals must:
- Not use SNF swing beds for acute level care.
- Comply with all other hospital conditions of participation and those SNF provisions set out at 42 CFR 482.58(b) to the extent not waived.
- Be consistent with the state’s emergency preparedness or pandemic plan.
Hospitals must call the CMS Medicare Administrative Contractor (MAC) enrollment hotline to add swing bed services. The hospital must attest to CMS that:
- They have made a good faith effort to exhaust all other options;
- There are no skilled nursing facilities within the hospital’s catchment area that under normal circumstances would have accepted SNF transfers, but are currently not willing to accept or able to take patients because of the COVID-19 public health emergency (PHE);
- The hospital meets all waiver eligibility requirements; and
- They have a plan to discharge patients as soon as practicable, when a SNF bed becomes available, or when the PHE ends, whichever is earlier.
This waiver applies to all Medicare enrolled hospitals, except psychiatric and long term care hospitals that need to provide post-hospital SNF level swing-bed services for non-acute care patients in hospitals, so long as the waiver is not inconsistent with the state’s emergency preparedness or pandemic plan. The hospital shall not bill for SNF PPS payment using swing beds when patients require acute level care or continued acute care at any time while this waiver is in effect. This waiver is permissible for swing bed admissions during the COVID-19 PHE with an understanding that the hospital must have a plan to discharge swing bed patients as soon as practicable, when a SNF bed becomes available, or when the PHE ends, whichever is earlier.
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Launch of Updated & Expanded Version of AHCA’s Infection Preventionist Training (IPCO)
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Phase III Requirements of Participation took effect November 28, 2019 and mandate that every nursing facility have a designated and specially trained Infection Preventionist who is running a comprehensive infection prevention and control program. AHCA recommends that each skilled nursing facility train at least two Infection Preventionists through
AHCA’s IPCO training program should one Infection Preventionist leave the facility. The training is also highly recommended for assisted living communities because they care for a similar population and face similar infection risks.
IPCO Version 2 is designed to train Infection Preventionists and is approved for 25 ANCC contact hours. The online course is also now approved for 22 NAB CEUs for Administrators. AHCA/NCAL recognizes Administrators will not serve as designated Infection Preventionists, but we recommend that Administrators consider taking the course to gain a deeper understanding of infection prevention and control in the overall operation of a nursing facility as this is a high target area for survey and liability.
A quick reminder that while CDC/CMS did release a free infection prevention training course in March 2019, AHCA’s IPCO Version 2 training is far more comprehensive and includes updated information. AHCA’s course also includes in-depth learning on topics such as water management, antibiotic stewardship and bonus content on key issues surrounding the COVID-19 pandemic.
About IPCO Version 2
Here’s what’s new and changed in IPCO Version 2:
- Updated regulatory requirements
- Increased from 23 to 25 ANCC contact hours for nurses
- Approved for 22 NAB CEUs for administrators
- Length of time allowed to complete the training increased from 9 months to 12 months
- Added course content:
- Multi-drug Resistant Organisms (MDROs) and Enhanced Barrier Precautions (EBP)
- Candida Auris
- Water management programs
- COVID-19
- Bonus Content – All persons who register for the course receive access to additional non-CE approved content. Topics include Interim COVID-19 Guidance, and courses on PPE and N-95 mask use.
The registration fee is $450 for AHCA/NCAL members and $650 for non-members. There are no refunds and no transfers. Payment and registration are made online at
ahcancalED. Discounted group purchase rates are available for groups of 25 or more. Refer group purchasers to
educate@ahca.org.
A Note About Current IPCO Version 1 Enrollees Who Have Not Yet Completed the Course
Those who are active enrollees in IPCO 1 but have not completed their coursework will be given access to all IPCO Version 2 modules and bonus trainings free of charge. However, they will only receive the 23 ANCC nurse contact hours approved for IPCO Version 1. All current IPCO Version 1 enrollees in progress of completing the course, will be notified of their ability to access IPCO Version 2 content.
IPCO 1 Renewals & Deadline Extension
IPCO requires three-year certificate renewals. The first version of IPCO launched in June 2017. Due to the COVID pandemic, AHCA is extending the expiration date of the specialized training certificate for IPCO by three months for all IPCO 1 certificate holders. So, the very first group of individuals who received an IPCO certificate in July 2017 will not need to renew their certificates until October 2020. AHCA will be notifying all IPCO 1 certificate holders of the extension once the renewal exam is available.
There are two options for renewal. Option one is to register for and successfully complete the IPCO competency renewal exam. Option two is to register for and take the IPCO Version 2 course and pass the IPCO Version 2 exam. AHCA will send additional information to state affiliates about the IPCO competency renewal exam in late May.
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Bureau of Assisted Living Regulatory Response to COVID-19 – Assisted Living Forum Tuesday, May 19, 2020
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Assisted living providers and stakeholders are invited to attend our Assisted Living Forum. During this time, Bureau of Assisted Living will provide answers to questions related to COVID-19 and assisted living facilities.
This session is conducted on Tuesdays from 10:00-11:30 a.m. until further notice. Please join on Tuesday, May 19, 2020.
To Join:
Meeting ID: 723 961 504
Or by Phone: +1 312 626 6799
Assisted living providers and stakeholders may submit questions to be addressed by completing this
survey no later than 4 p.m. the Friday before the forum.
Please use the question & answer (Q&A) feature within the Zoom meeting room to submit questions during the forum. Questions related to funding should be submitted to the Managed Care Organizations or Division of Medicaid Services.
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Stimulus Checks Do Not Affect Medicaid Eligibility
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There has been some confusion related to Medicaid eligibility due to the Economic Impact Payments (EIPs) paid to residents. Under Medicaid rules, a stimulus payment is not counted as income. Therefore, receiving a stimulus payment does not change a resident’s monthly payment (often called a “patient pay amount” or “share of cost”). The resident pays the same monthly amount to the nursing facility and keeps the stimulus payment for their own use.
In addition, the stimulus payment does not count as a Medicaid resource for 12 months. In other words, for the first year, the payment cannot cause you to have “too much” savings.
Please
click here
for more details on these clarifications.
AHCA/NCAL has seen at least two examples of state Medicaid agency misinterpretations of EIP indicating that is does impact Medicaid eligibility. This is incorrect. DHHS and Treasury officials are in contact with CMS State Affairs staff working on clarifying guidance to state Medicaid agencies.
If you have encountered problematic guidance, please contact WHCA/WiCAL Director of Reimbursement Policy
Kate Dickson
.
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WHCA/WiCAL Supports the Strengthening Innovation in Medicare and Medicaid Act
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WHCA/WiCAL recently signed onto a letter to support H.R. 5741, the Strengthening Innovation in Medicare and Medicaid Act.
This bipartisan legislation will make significant strides in addressing patient and provider concerns about the impact of the Center for Medicare and Medicaid Innovation (CMMI) demonstrations on access to care and the quality of care.
H.R. 5741 provides safeguards for CMMI to ensure CMMI demonstrations are patient-focused and benefit beneficiaries. In the long run, improving healthcare delivery and quality is the best way to achieve sustainable cost savings.
Click
HERE to view the letter.
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Pat Boyer, MSM, RN, NHA
| Director of Quality Advancement and Education |
pat@whcawical.org
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Business Partner Spotlight
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Why Should Your Organization Choose CE Solutions?
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Deb Martin
866-650-3400
For the complete listing of WHCA/WiCAL Gold Business Partners, click
HERE
!
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