June 11, 2020
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UPCOMING EVENTS CALENDAR:
Tuesday, June 16 at 10:00 AM:
Bureau of Assisted Living Regulatory Response to COVID-19

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Meeting ID: 723 961 504

Or by Phone: +1 312 626 6799

Tuesday June 16 at 1:00 PM
CDC COCA Call: Applying COVID-19 Infection Prevention and Control in Nursing Homes


Phone: 1-669-254-5252 or 1-646-828-7666 

Webinar ID: 161 554 3668
SAVE THE DATES:
COVID-19 Updates: June 11, 2020
This update includes:
  • WHCA/WiCAL Raises Concerns about CARES Act Funding Requirements
  • Auto-Generated Citations for Failure to Report in NHSN Now Being Issued by CMS – Be Sure to Check Your Facility’s CASPER
  • Relief Fund Portal for Medicaid Providers Launches
  • AHCA Focuses on COVID-19 in SNF PPS Proposed Rule Comments
  • FAQs: Medicaid Provider Portal for AL and ID/DD
  • FDA Removes Many Respirators Manufactured in China from Approved List for Decontamination
  • Nursing Homes Facing Financial Crisis
  • Department of the Treasury Announces Relief from 60% Cliff
  • Mark Parkinson: "We Won't Back Down"
  • How to Make COVID-19 Notifications Meaningful
  • Jessica Radtke Named Deputy Director of the DQA Bureau of Nursing Home Resident Care
As of today, there are 21,926 confirmed cases of COVID-19 in the state of Wisconsin and 682 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.
WHCA/WiCAL Raises Concerns about CARES Act Funding Requirements
WHCA/WiCAL earlier today sent the below letter to State Medicaid Director Jim Jones regarding the CARES Act Provider Funding program.

Jim,
 
The purpose of this communication is to express the concerns of my members regarding the way that the Wisconsin Department of Health Services has designed the CARES Act Provider Funding program. With providers receiving funding from multiple sources simultaneously, and then stipulating that those funding sources be mutually exclusive raises significant questions about whether many providers will be in a position to benefit from this funding. The requirements associated with this program also raise the concern that providers will not be in a position to have funding available for the operation later in the year, when they will need it.
 
When providers received funding through the tranches of federal funding that the U.S. Department of Health and Human Services (HHS) provided, this money was made available to stabilize the financial situation for providers for an entire year – not only for the months of March, April and May. For the entirety of this funding to be deducted from any available CARES Act funding, as opposed to an amortized portion of the three months that this funding applies to, will mean many providers will not be in a position to receive any reasonable amount of funding in this first round.

The application should give providers the opportunity to neutralize their rate increases they have been fighting for years for. WHCA/WiCAL believes that the 6.4% rate increases that SNFs were allocated has nothing to do with COVID-19 and should not count against them when demonstrating revenue losses. Some providers have also experienced a higher Medicare rate under the PDPM system that was implemented on October 1, 2019 than they did under the previous RUGs system. So when the Department looks to determine the impact of COVID-19 between corresponding periods of 2019 and 2020, the impact is understated and misleading due to the increase in the Medicare PDPM rate. However, there could be additional ancillary expenses (PT, OT, ST, pharmacy, IV, lab and x-ray) also applicable to the Medicare residents being cared for under PDPM, which is not taken into account in the current application for funds. Due to these factors WHCA/WiCAL would request that instead of using lost revenue as the basis to determine funding, the state use the impact of loss census which would neutralize the impact of rate increases which were not a result of COVID-19.

It is also important to note that if the funding is intended to help those who have not benefitted from the federal CARES payments, it is now unequitable to make providers who had received that funding before June 5 th deduct it but now the newly announced $15 billion for Medicaid providers won’t count against those providers even though it was released only five days later.

WHCA/WiCAL would recommend that providers be given the opportunity to amortize the HHS tranche funding over the entire year, not for only the three months covered in the reporting period. It was also indicated during the Residential Representatives meeting held yesterday that this aspect of program design was a decision that was made internally within the Wisconsin Department of Health Services, and not a Federal requirement.
 
Finally, I would encourage you to review the following financial crisis report that our national association has put together on the fiscal challenges facing skilled nursing facilities around the country: https://www.ahcancal.org/News/news_releases/Documents/Nursing-Homes-Facing-Financial-Crisis.pdf
 
I look forward to having the opportunity to discuss this matter with you and your team. I have also CC’d Lisa Olson on this email, as well as BCC’d the providers who participate in her “Kitchen Cabinet” group that advises the Secretary and the Executive Team on matters of concern to the LTC provider community.
 
Best,
 
John J. Vander Meer, MPA
President & CEO
Wisconsin Health Care Association
Wisconsin Center for Assisted Living
Auto-Generated Citations for Failure to Report in NHSN Now Being Issued by CMS – Be Sure to Check Your Facility’s CASPER
CMS began automatically issuing CMPs to facilities who it determined failed to report NHSN data by June 7, 2020. The CMS Imposition of Remedy Letter states, “This compliance review confirmed our facility was not in substantial compliance due to failure to report complete information to NHSN about COVID-19 in the standardized format and frequency as specified by CMS and the CDC.”

WHCA/WiCAL continues to hear of concerns about functional issues with the NHSN reporting module. We continue to recommend that providers document all communications and attempts to report information. IIDRs for these CMPs will be reviewed through Healthcare Management Solutions, LLC, based out of West Virginia, rather than through Maximus. This information is included in the documentation that facilities receive after being cited for failure to report data in NHSN.

Below are examples of documentation to help show proof of your efforts to be compliant with the NHSN reporting requirements. It may be helpful to organize all this information in chronological order and in one location.

  • Any documentation on the dates you reached out to NHSN for help with technical issues/registration issues 
  • Any documentation that provides a response to your question to the NHSN help desk 
  • SAM registration information and dates 
  • All email confirmations from NHSN or CDC about your communications and registration  
  • Copies and screen shots of any error messages you received  
  • Documentation of data you collected on NHSN forms if/when you were unable to input it into the online system while awaiting response to technical or registration issues 
Relief Fund Portal for Medicaid Providers Launches
On June 10, the U.S. Department of Health and Human Services (HHS) launched a web application portal for Medicaid providers other than SNF Medicaid providers. SNF Medicaid-only providers already should have received a Medicaid Allocation or will receive payments over the course of the week. The new  Provider Relief Fund Payment Portal will initially be used for new submissions from Medicaid and Children’s Health Insurance Program (CHIP) providers seeking payments under the Provider Relief Fund including assisted living communities, ICFs/IID, and home and community-based providers.

HHS also as prepared instructions on how to complete the Medicaid Distribution and a downloadable PDF of the application. The latter should be used a worksheet in conjunction with the instructions before entering data into the web portal. Ensuring accuracy of web portal data entry is important because once an application is submitted, it may not be modified.

Of note, the new Provider Relief Fund Payment Portal also may be used by providers who did not receive payments under the previous General Distribution, including those providers who bill Medicaid and CHIP (e.g., pediatricians, long-term care and behavioral health providers.). For example, providers who engaged in a change in ownership and who also had Medicaid revenue during a specified period ( see FAQ summary) may use the Payment Portal to request funds.

To view a summary of FAQs pertaining to the new Payment Portal as well as other June 10 FAQ updates highlights, read more from our blog post. Of note, HHS discusses use of funds for longer term expenses and lost revenue in its updated FAQs.

If you have questions about CARES Act Provider Relief Fund awards, please contact the Fund Hotline at (866) 569-3522; for TTY dial 711. Use of the Hotline is the most expeditious way address questions. HHS will not respond to provider-specific questions.
AHCA Focuses on COVID-19 in SNF PPS Proposed Rule Comments
On Tuesday, AHCA submitted comments on the Fiscal Year 2021 Skilled Nursing Facility Prospective Payment System Notice of Proposed Rulemaking. All of AHCA’s comments focus on COVID-19 and ensuring patient and staff health and safety through accurate and adequate reimbursement.

In its comments, AHCA praises CMS for the Patient-Driven Payment Model (PDPM). Without PDPM’s focus on patient characteristics and related shift away from service-based metrics, specifically therapy minutes, we believe delivering care during the COVID-19 crisis would have been almost impossible. AHCA applauds CMS’ waiver flexibilities. The letter highlights AHCA’s related Interim Final Rule with Comments letters urging CMS to make its telehealth waivers permanent.

These have been critical to delivering care during the pandemic as well as to make much needed changes to the MDS guidance to allow two patients with COVID-19 to be placed in the same room. Other key comment areas include a request that CMS reweight and revise the market basket to reflect new, ongoing COVID-19 related costs and to work with the profession and Congress to add patient COVID-19 testing to consolidated billing. AHCA’s comments also note the profession’s focus on quality, highlighting that during the waiver of certain quality reporting requirements, we have continued to work with members on outcomes for patients and families.
FAQs: Medicaid Provider Portal for AL and ID/DD
On June 10, the U.S. Department of Health and Human Services (HHS) updated its Provider Relief Fund FAQs. The update provides information on the new web application portal for Medicaid providers other than SNF Medicaid providers. SNF Medicaid-only providers already should have received a Medicaid Allocation or will receive payments over the course of the week. The new Provider Relief Fund Payment Portal will initially be used for new submissions from Medicaid and Children’s Health Insurance Program (CHIP) providers seeking payments under the Provider Relief Fund including assisted living communities (ALs), ICFs/IID, and home and community-based providers.

Click HERE to learn more.
FDA Removes Many Respirators Manufactured in China from Approved List for Decontamination
In a June 7 press release, the FDA announced that it has modified its guidance related to the decontamination of many respirators manufactured in China. 

“In response to public health and safety concerns about the appropriateness of decontaminating certain respirators, the agency is reissuing certain emergency use authorizations (EUAs) to specify which respirators are appropriate for decontamination. Based on the FDA’s increased understanding of the performance and design of these respirators, the FDA has decided that certain respirators should not be decontaminated for reuse by health care personnel.” 

“For example, the FDA has learned from the Centers for Disease Control and Prevention's (CDC) National Institute for Occupational Safety and Health (NIOSH) testing that authorized respirators manufactured in China may vary in their design and performance. As such, the FDA has determined that the available information does not support the decontamination of these respirators and has accordingly revised the relevant EUAs. In addition, the FDA is also revising relevant EUAs to no longer authorize decontamination or reuse of respirators that have exhalation valve” 

The list of respirator models that no longer have Emergency Use Authorization for decontamination can be found here.  
Nursing Homes Facing Financial Crisis
AHCA/NCAL recently released a report entitled "Financial Crisis of Nursing Home Industry: COVID-19 Exposing Medicaid's Chronic Underfunding, Requiring Significant Resources and Putting Industry on Verge of Collapse."

Pre-COVID:
  • Medicaid reimbursements only cover 70 to 80 percent of the cost of care (Medicaid covers more than 60 percent of all nursing home residents)
  • Average nursing home operating at a loss or razor thing profit margin (-0.3% on average in 2018)

With COVID:
  • Supplies to fight COVID-19 can increase costs up to 103 percent 
  • Labor costs have increased up to 18 percent on average 
  • Estimated revenue loss of up to 23 percent or $57 billion

“The long term care industry welcomes the opportunity to work with Congress and the Administration on innovative solutions that address the real challenges ahead in terms of providing quality care while preserving and enhancing the vital Medicaid program for millions of Americans,” said AHCA/NCAL President & CEO Mark Parkinson.
Department of the Treasury Announces Relief from 60% Cliff
On June 8, 2020, U.S. Department of the Treasury (Treasury) Secretary Steven Mnuchin and Small Business Administration (SBA) Administrator Jovita Carranza issued a statement regarding the enactment of the  Paycheck Protection Flexibility Act of 2020  (the Act), which Congress passed on June 3, 2020 and President Trump signed into law on June 5, 2020.

There had been concern that the language of the Paycheck Protection Program Flexibility Act could cause businesses that spent less than 60% of the proceeds on payroll costs to end up with no debt forgiveness, creating a “cliff”. 

However, the announcement indicates that the SBA guidance will provide that a minimum of 60% of the amount forgiven must consist of payroll costs, rather than providing that if less than 60% of the loan proceeds are used for payroll costs there would be no forgiveness of the loan.

The statement provides that the change will:

Lower the requirements that 75 percent of a borrower’s loan proceeds must be used for payroll costs and that 75 percent of the loan forgiveness amount must have been spent on payroll costs during the 24-week loan forgiveness covered period to 60 percent for each of these requirements. If a borrower uses less than 60 percent of the loan amount for payroll costs during the forgiveness covered period, the borrower will continue to be eligible for partial loan forgiveness, subject to at least 60 percent of the loan forgiveness amount having been used for payroll costs.

They also noted that they will promptly issue rules and guidance, a modified borrower application form, and a modified loan forgiveness application implementing the legislative amendments to the PPP. 
Mark Parkinson: "We Won't Back Down"
A message from AHCA/NCAL President & CEO Mark Parkinson:

Our profession faces its greatest challenge in history. This isn’t like the usual fight we have in D.C. over a two percent increase or cut, or over some crazy regulation. Instead, this is a battle for the lives of our residents, our staff, and the very survival of our sector. 

We didn’t cause the COVID-19 crisis, but we will be a large part of the solution. 

Click HERE to view the full message.
How to Make COVID-19 Notifications Meaningful
AHCA/NCAL has heard concerns from members about the challenges nursing homes are facing in following CMS requirements for notifications to residents, their representatives and their families in a meaningful and useful way. CMS requirements for confirmed and clusters of suspected cases to be notified in an ongoing cumulative way is creating confusion for the people these notifications are supposed to serve. While nursing homes must continue reporting in  this cumulative manner in order to meet the current CMS requirements, AHCA suggests nursing homes consider including additional information in these notifications that is more meaningful and useful to residents, their representatives and families. 

AHCA/NCAL has developed additional, optional items in this template letter to residents and families as suggestions for you to consider including: 

  • Number of residents or staff with confirmed COVID-19 
  • Number of residents and staff who have recovered from COVID-19 
  • Number of residents and staff who have tested negative for COVID-19 
  • The number of days since a new resident or staff member has tested positive 

These items are not required, nor are they prohibited. Along with providing numbers, make sure to provide updates to residents and family members about efforts you are undertaking to address the situation and how you will continue to keep them informed. This template letter is not just about fulfilling CMS requirements, but fostering a good relationship with those you serve. 

The template letter may also be used by Assisted Living Communities. Nursing homes and assisted living communities may further adapt or tailor these letters as they see fit. 

As with all information included in these notifications, make sure you adhere to existing privacy requirements and do not include Personally Identifiable Information (PII), such as names or specific medical information. 
Jessica Radtke Named Deputy Director of the DQA Bureau of Nursing Home Resident Care
BNHRC Director Ann Angell announced today that Jessica Radtke has been selected to serve as the bureau’s Deputy Director. Radtke had previously served as the RFOD for the Northern Regional Office. She has been in her new role since Monday, June 8.

Since Radtke’s promotion creates a vacancy in the RFOD position for the NRO, Tammy Modl, WRO RFOD, will also be overseeing the NRO until a replacement is named.

Bureau Director Ann Angell had previously served as Deputy Director, and the position had been vacant since her promotion to Director earlier this year.
WHCA/WiCAL Staff
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 Policy | kate@whcawical.org

Kate Battiato, MPA | Director of Workforce Development | kbattiato@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

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For the complete listing of WHCA/WiCAL Gold Business Partners, click  HERE !
WHCA/WiCAL | 608.257.0125 | info@whcawical.org | www.whcawical.org