• Skilled nursing facilities are included.
• Payments to Medicare providers will be based on 2019 Part A and Part B billings.
• Funds are expected in accounts as early as today and at the latest next week. Providers are reporting nationwide, receiving payments today from United Healthcare. 
• Funds are grants and not loans. 
• This is different than the CMS Accelerated and Advance Payment Program. Both can be participated in. 
• The Administration is working rapidly on targeted distributions that will focus on providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans. 

• Allowing hospices to use pseudopatients (mannequins or role players) in aide competency training; and
• Waiver of the annual 12-hour in-service training requirement for hospice aides. The hospice chart is updated here. Additional analyses, as needed, for other settings will be provided soon.

• Surveyors will ask for the completed self-assessment infection control tool that was issued by CMS. LeadingAge has created an Infection Control COVID-19 tool and checklist and should be used in conjunction with the CMS self- assessment tool. Using the LeadingAge tool helps to fill in gaps.
• Helps to identify gaps in COVID-19 preparedness
• Gives you a guide to basics in what you should be doing in your building
• It helps you with your preparedness efforts for COVID-19

• Have a thoughtful, meaningful plan
• Think through scenarios, so you have a plan when you have your first COVID-19+ case in your building, or half of your staff is unable to work
• Completing the self- assessment tool is not a one and done, but constantly evolving; revisit often to figure out how to operate on a day to day basis

• How are you mitigating PPE shortages? Follow CDC guidelines for optimizing supplies, optimizing current supply or identify next best options for residents including prioritizing use of PPE
•  Is your organization notifying proper authorities to get more PPE or informing them that your supply is running low? Provide documentation to support efforts

• Respiratory /Cough Etiquette- include teaching residents but surveyors will also be observing staff to ensure they are adhering to proper etiquette
• Cleaning and disinfecting equipment- how are you reprocessing reusable equipment such as B/P cuffs, glucometers, etc.

• Are staff performing when indicated and while assisting residents with hand hygiene?
• What do staff do when there are no hygiene supplies such as hand sanitizer?
• Are staff donning PPE on and off correctly?

• Are staff able to identify droplet, airborne and contact precautions? Do they know which precautions to use with identified residents?
• Are staff aware of which precaution to use for unidentified respiratory infections?
• Are staff aware of Aerosol Generating Procedures (APGs)? Do they know what precautions to use for APGs? What PPE to wear?
• Masks- are staff aware of which one to wear and what PPE to wear when entering a resident’s room?
• How are staff monitored for wearing the appropriate PPE?

• If there is a positive Covid-19 case or presumed positive case, how are staff taking care of resident in their room? How do you handle the positive person that needs to leave the room ( i.e. go to dialysis or hospital -how is this communicated?)
• Are residents being co-horted?
• How is isolation being handled?
• How are you managing and monitoring symptoms?

• Are all access points of your building consolidated? Do not allow any entry into building that is closed off- even for surveyors
• Are there screenings for symptoms at all access points?

• Provide documentation regarding education provided to staff on COVID-19 including symptoms, how it is transmitted, screening criteria, work exclusion
• Document updates provided to staff regarding COVID-19 in your building
• Outline steps if staff develop symptoms including if they are symptomatic during screening, develop during work hours, or if they are calling in from home

• How do you ensure you have enough staffing? Include nursing, dietary, housekeeping and all essential staff
• What is your back up plan when specialized staff such as physician or infection preventionist are unable to work? Consider having several staff certified in infection prevention. The course is offered online is free.
• How do you ensure that the facility operates according if your Administrator or Director of Nursing is not working?

• CARES Act.  On funding flowing from the CARES Act to Project-Based Rental Assistance, Section 202, and Section 811, most of this money will flow to replace reduced tenant incomes because of COVOD-19. The funding to replace tenant incomes will be triggered by tenant recertifications and should be a fairly quick and invisible process. For the portion of funding going to Service Coordinators, this is slightly more complicated because these dollars usually would come with a NOFA and a longer process. Work is being done on the procedures to see what can be done to waive and what they can do to get that funding out to properties as quickly as possible. 
• Eviction Moratorium in CARES Act: For federal housing there’s a 120 day moratorium beginning March 27. No eviction for nonpayment of rent, no late fees. Tenants should be very careful with how they respond to this moratorium. Evictions are still possible after the end of the moratorium and tenants are still responsible for their portion of the rent. Resource materials are being developed for residents to help them understand their rights and responsibilities under this moratorium, and this should be coming soon. Tenants should also be aware that wile Act prohibits evictions for nonpayment of rent, evictions are still possible for other lease violations so residents should be mindful of how they think about that moratorium.

• Tenant Income Recertifications. A lot of time spent in Multifamily thinking how there can be a reduction in the administrative burden and the face-to-face contact that is generally a part of annual and interim recertifications. Several tenants are affected by lost hours and this impacts their economic situation at home and their ability to pay their portion of rent. A number of steps have been gone through a number of steps to make this more straightforward for residents and owners. Tenants can complete annual and income recertifications within 90 days of their regularly scheduled date. If a tenant has problems completing certification materials, they can tell their landlord and then tenants will have up to 90 days to complete these. For lost income for both annual and interim certifications, it is allowable for tenants to self-certify or to provide family certifications in place of regular documentation. Openers need to document in their files why no third party documentation was present. COVID-19 and all the issues surrounding that present extenuating circumstances and self- and family-certifications are being accepted.

• Signatures.  Where signatures are required in person and in ink, it is allowed for copies of signatures, photographs of signed documents, and emails of signed documents to be provided to owners as documentation. Owners must document why wet signatures were not documented and their plan to collect these at a later date. This includes signatures on HUD forms 9887 and 50059. These can be provided electronically. Owners need to provide their code in the TRACS system as to why this unusual form of certification was provided. There are three codes they might use: 1) medical, 2) extenuating circumstance, and 10) other. Owners need to maintain 90% of their tenants in active status to ensure their subsidy to their property will continue to flow.

• Visitors at Properties. Owners and tenants are both concerned. Owners should be very mindful of all fair housing restrictions and regulations that apply to tenants. Owners should not do anything that violates tenants’ rights and their ability to use and enjoy their residences in a normal way expect when guided otherwise by the CDC or local health or law enforcement officials. So, use local guidance, use common sense, be mindful of the rights of residents. HUD does not provide any additional guidance other than what is provided by the CDC and state and local health and law enforcement officials.

• Questions of HUD. Members with questions for HUD to address, can send them here.

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