March 26, 2020

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Pathway Health developed a full set of complimentary COVID-19 resources for your use, including policies and procedures, leadership checklists, preparation and response strategies. 

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COVID-19 Updates: March 26, 2020

This update includes:

As of today, there are 707 confirmed cases of COVID-19 in the state of Wisconsin and five deaths caused by the virus. Click HERE to view the latest outbreak information from the Wisconsin Department of Health Services.

U.S. Senate Passes Stimulus Package

On March 25, the Senate passed the Coronavirus Aid, Relief, and Economic Security Act (H.R. 748), which now goes to the House of Representatives for consideration. Of note to skilled nursing facilities and assisted living facilities, the stimulus includes:

We expect the House to pass this bill later this week, and once it passes, we will offer a more detailed summary of the various provisions specific to long term care. 

WHCA/WiCAL Submits Assisted Living Waiver Requests

On Wednesday, March 25, WHCA/WiCAL along with LeadingAge Wisconsin and the Wisconsin Assisted Living Association submitted waiver requests to the Department of Health Services. The requested waivers include state administrative rules relevant to CBRF (Ch. 83), AFH (Ch. 88), and RCAC (Ch. 89).

To view the waiver request, click HERE.

COVID-19 State Legislative Request

John Vander Meer, President & CEO of WHCA/WiCAL, along with representatives of LeadingAge Wisconsin had a conference call yesterday with Representative John Nygren and Senator Alberta Darling, Co-Chairs of the Legislature’s Joint Committee on Finance regarding the significant increased costs associated with response to COVID-19.

 

It was clear that both Darling and Nygren understand the provider community’s significant concerns related to the provider community’s key priorities of workforce and the availability of PPE. Both legislators indicated that there are still a significant questions about how the process for consideration of the funding package will be determined.

 

WHCA/WiCAL encourages facilities located in districts with members of the Joint Finance Committee to contact their legislators.

 

Key Documents:

 

PPE:  There is a critical shortage of available Personal Protective Equipment.

 

WORKFORCE:  Wisconsin LTC facilities have been experiencing a workforce shortage. Wisconsin facilities have a 1 in 4 vacancy. No one really knows what a COVID-19 world with the Safer at Home Policy, unemployment benefits, lack of available PPE, lack of childcare, and the need for some people to take care of their own parents will mean for our staffing. Our associations want to communicate the fear that we hear in the dozens of calls our organizations take from providers every day. 

 

We requested that a legislative relief package in response to the COVID-19 pandemic address the needs of long-term care facilities as providers work to protect and care for Wisconsin’s frail elderly population during this public health emergency

Ozaukee/Washington County Lockdown Orders

In response to an outbreak of COVID-19 at a senior living center in Grafton, the Washington Ozaukee Public Health Department has issued a new order, which:

See the new order here.

This order is in addition to a previous order which imposed the below requirements, among others: 

The order applies to all LTC facilities. Some/most of these restrictions have already been implemented in SNFs and in many ALs. Requirements include:

View the first Washington Ozaukee public health department order here .

WHCA/WiCAL continues to express significant concern about so-called “lockdown” orders by county and municipal health departments. So far Ozaukee, Washington, Racine, Jefferson and Dane Counties, as well as the City of Appleton are the localities know to have each issued similar orders requiring the constant use of PPE among staff without providing any consideration of the limited supply of PPE that is available. Given the shortage of available PPE, and the conflicting orders between local, state and federal governments, members are encouraged to exercise their best judgement in the use of available PPE, in accordance with CDC guidelines. Facilities located in areas where these orders have or will be put into effect, members are encouraged to contact their local public health departments to express their concerns about the effects that these orders have on the availability of PPE. During the briefing call with LTC stakeholders on Tuesday afternoon, Jeanne Ayers, Administrator of the DHS-Division of Public Health said that local public health can issue more restrictive guidance than the state does, and those orders are within their authority. WHCA/WiCAL has requested Ayers to ask local health departments to qualify these recommendations, and facilitate the coordination of more clear communication between state and county officials. 

Malicious IP Addresses for Healthcare

Thank you to WHCA/WiCAL Elite Premier Business Partner, M3 Insurance, for sharing the below information:

M3 Insurance received the above credible intelligence from the Wisconsin Cyber Threat Response Alliance (WICTRA, and off-shoot of the WI National Guard); this is a list of IP addresses that are known to be launching cyber-attacks directly at the healthcare sector. Any IT professional should know how to block incoming traffic from these IP addresses.

Directive: hand this off to your IT people/team and enter this into the firewall and block IT addresses attached.

COVID-19 Testing Capacity Expands

Additional health systems and labs in Wisconsin will have the capability to do COVID-19 in-house testing.

 

ACL Laboratories, part of Advocate Aurora Health, will be able to process COVID-19 tests for emergency department patients authorized for inpatient admission, those being treated in hospitals and team members as of Monday.

 

The lab plans to be able to process at least 400 tests a day and provide results back in fewer than 24 hours for the affected populations.

 

Gundersen Health System has developed a test to detect COVID-19, which will allow the health system to process the results in house, reducing the wait time for results.

 

The University of Wisconsin-La Crosse provided the Gundersen with enough supplies for thousands of tests. 

 

The Wisconsin State Lab of Hygiene, Milwaukee Health Department and national labs - including LabCorp and Quest - are also running tests in the state. 

 

In addition, Children’s Wisconsin and Froedtert Health have confirmed in-house testing for their patients.

Emergency COVID-19 Relief Funding for Contracted Inclusa Providers

Please see the attached letter from Inclusa. Inclusa is offering two different types of relief funding totaling over $2,000,000 per month through the duration of the COVID-19 pandemic. These payments will be made payable to providers using the federal tax ID (EIN or SSN) as identified on your organization’s W9.

MCO FAQs

Following a recent Division of Medicaid Services call, DHS shared a Frequently Asked Questions document that they provided to MCOs. This document is helpful for providers to review current policies that MCOs are expected to follow and it will be posted to Family Care website for future reference, along with any subsequent versions. 

Nursing Home Interim Rates Forthcoming

Due to the COVID-19 pandemic, Wisconsin Medicaid will be issuing interim rates for skilled nursing facilities that have not yet received draft or finalized July 1, 2019, Medicaid reimbursement rates. For facilities that have not yet received draft rates, no action is required. Your auditor will set interim rates based on your audited 2017 cost report, using the current period rate formula and acuity. These rates will be uploaded to ForwardHealth. Remittance advices are expected to show claims adjustments related to the revised rates beginning on March 30. Adjustments may continue to process throughout that week, resulting in additional payments.

Facilities that have received draft cost report adjustments and rates will not receive interim rates. Please contact your regional auditor to finalize and approve your rates so that claims adjustments reflecting the new rates can begin.

Cost report audits for 2018 will continue. Facilities without finalized rates should continue to work with their auditor.

UHC and Cigna Waive Prior Authority for Post Acute Care

Healthcare insurer giant UnitedHealthcare (UHC) has announced that it will be suspending prior authorization requirements for post-acute settings through May 31, 2020, with the waiver applying to long-term care facilities (LTCFs), acute inpatient rehabilitation (AIR), and skilled nursing facilities (SNFs).

Link:  COVID-19 Prior Authorization and Ongoing Patient Care Updates  

Cigna has announced a similar waiver, noting on its website that it was making it easier for "for hospitals to transfer patients to long-term acute-care hospitals (LTACHs) and other sub-acute facilities to help manage the demands of increasingly high volumes of COVID-19 patients." Cigna also said that in place of prior authorizations, it would require notification from the LTACH on the next business day following the transfer.

"This policy will remain in place through May 31, 2020, and applies to Cigna commercial and Medicare Advantage plans," the announcement read. "Cigna has also waived prior authorizations for the transfer of its patients to other in-network sub-acute facilities, including skilled nursing facilities and acute rehab centers."

Link:  Cigna Makes It Easier For Hospitals To Focus On COVID-19 By Helping Accelerate Patient Transfers

Federal Court Orders Appeal Rights on “Observation Status” Issue for Certain Medicare Hospital Patients

In a   decision   issued March 24, 2020, Judge Michael P. Shea of the U.S. District Court in Hartford, Connecticut found that certain Medicare beneficiaries who are placed on “observation status” at hospitals, rather than being admitted as “inpatients,” have the right to appeal to Medicare. The case, Alexander v. Azar, is a nationwide class action case filed by the Center for Medicare Advocacy that went to trial in August 2019. The ruling finds that as a matter of constitutional due process, patients who are initially admitted as inpatients by a physician, but whose status is later changed to observation by their hospital, have the right to appeal to Medicare and argue for coverage as hospital inpatients.

The decision opens the door to medically necessary services in skilled nursing facilities that Medicare beneficiaries might otherwise have to forgo because they cannot afford to pay for it themselves. The distinction between being labeled a hospital “inpatient” versus being placed on observation status is important because Medicare only covers subsequent care in a skilled nursing facility for patients who were hospitalized as inpatients for three or more consecutive days. Patients in observation status are considered “outpatients” and thus ineligible for coverage of care at nursing facilities. You can read the full press article about this on the Center for Medicare Advocacy’s website   here . 

NEW Video Tutorials Available to Assist with Coding Specific Section GG Items

The Centers for Medicare & Medicaid Services (CMS) released three short video tutorials to assist providers with coding three specific Section GG items of the Minimum Data Set (MDS). These videos, ranging from 5 to 10 minutes, are designed to provide targeted guidance using simulated patient scenarios. To access the videos, click on the links below:

If you have technical questions or feedback regarding the training, please email the   PAC Training mailbox . Content-related questions should be submitted to the Quality Reporting Program Help Desk.

Families First Coronavirus Response Act Posters

Wisconsin Emergency Assistance Volunteer Registry (WEAVR) Program

The Wisconsin Emergency Assistance Volunteer Registry (WEAVR), is a secure, password-protected, web-based volunteer registration system for health care and behavioral health professionals. Volunteers interested in filling critical response and recovery roles following a major public health emergency self-register and are the only ones that can update their information.

Based on the information collected from each volunteer, public health officials identify those individuals willing to fill the specific volunteer roles needed in an emergency. Public health officials will use the WEAVR registry to generate a list of volunteers to be contacted. Those contacted will be given information on where to report and the role that is needed, as well as the option to accept or decline the opportunity. Training will be provided at the reporting site.

More questions about WEAVR? See a list of  Frequently Asked Questions .

Distance Learning Temporary Policy

The Wisconsin Department of Health Services (DHS) and the University of Wisconsin – Green Bay, Wisconsin Community-Based Care and Treatment Training Registry has approved distance learning to occur in the event that in-person classes are not possible until DHS and the Centers for Disease Control (CDC) determine the current COVID-19 emergency has ended.

This plan covers all department approved classes managed by the registry including the Assisted Living Administrators Course and Train-the-Trainer Courses. All efforts should be made to hold classes in person when possible when it has been determined that it does not place the participant and instructor’s health and safety at risk. Distance learning must meet the requirements outlined in the Distance Learning Temporary Policy.

The Distance Learning Temporary Policy is available on the Wisconsin Community-Based Care and Treatment Training Registry

For questions contact the University of Wisconsin-Green Bay at registry@uwgb.edu or 920-465-2772.

Wisconsin Senior Medicare Fraud Alert

Unfortunately, as the world is dealing with a pandemic, fraudsters are finding ways for personal gain during these uncertain times. Scams related to the coronavirus, also known as COVID-19, are rapidly increasing as the public health emergency continues. Scammers are targeting older adults and fraudsters are attempting to bill Medicare for sham tests and treatments. This fraud alert will help you understand a bit more about what the fraudsters are attempting to do and how Medicare beneficiaries can protect themselves from this fraud.

If you, or someone you are in contact with, have been the victim of a COVID-19 Medicare scam, please contact the Wisconsin Senior Medicare Patrol to report this suspected fraud. They can be reached toll-free, (888) 818-2611 or by email, smp-wi@gwaar.org.

WHCA/WiCAL Staff

As a reminder, WHCA/WiCAL's staff team is ready to serve your facility. We are committed to providing members with the services you need to succeed in your mission to provide high-quality care to Wisconsin's most vulnerable residents.

John Vander Meer, MPA | President & CEO | john@whcawical.org

Jim Stoa, J.D. | Director of Regulatory Affairs and Government Relations | jstoa@whcawical.org

Pat Boyer, MSM, RN, NHA | Director of Quality Advancement and Education | pat@whcawical.org

Kate Dickson, MPA | Director of Reimbursement | kate@whcawical.org

Allison Cramer | Communications and Government Relations Specialist | allison@whcawical.org

Jena Jackson | Director of Development | jena@whcawical.org

Jammie Moore | Director of Administrative Services | jammie@whcawical.org