COVID-19 UPDATE #35
May 26, 2020
UPDATE: FEDERAL ASSISTANCE AND B&O TAX LIABILITY
Washington’s B&O tax has raised some consternation among businesses receiving financial relief under the CARES Act, including but not limited to the federal paycheck protection program (PPP), about potential tax liability. Similar to the ongoing confusion and uncertainty regarding federal income tax treatment of PPP loan forgiveness, the ultimate answer is currently uncertain.
 
In a recent article posted on Washington Department of Revenue’s (WDOR) website, titled “Federal Financial Assistance Regarding COVID-19,” the Department acknowledges that “many businesses are receiving federal financial assistance to cope with the impacts of the COVID-19” and that it has been receiving questions whether such assistance is subject to Washington B&O tax. The article does not take a position on the topic, but it does state that businesses receiving federal assistance (including loan forgiveness under the PPP) “should  NOT  report” such amounts on their Washington tax returns and “should  NOT  pay” B&O tax on those amounts “at the present time.” (Emphasis in original.)  Thanks to the tax team at Lane Powell PC for keeping us updated.
DEAR ADMINISTRATOR LETTER UPDATES SKILLED NURSING PROVIDERS ON STATE PORTAL TO REPORT REQUIRED COVID-19 DATA
A Dear Administrator letter dated May 22, 2020, provides an update on the state’s portal to report required COVID-19 data to the Centers for Disease Control and Prevention (CDC). The state has been working on a system allowing providers to report the required information, and the system is now open. The letter explains how to get set up to report data. Facilities must be registered users on the NHSN website in order for data to be uploaded. If you are not registered on the NHSN website, you can learn how to do that here .

The letter includes instructions on getting set up to report required data. It also includes information on how to verify data and how to troubleshoot problems. Providers are also reminded that reporting must be done at least once per week. If you choose not to utilize the state portal, you must continue to report via the NHSN website or seek a second party to submit the data on your facility’s behalf. If you have questions about the state portal or the information in the letter, you can reach out to Lisa Herke, Nursing Home Program Policy Unit Manager at (509) 209-3088 or via email .
SKILLED NURSING FACILITY COVID-19 TESTING SURVEY RESPONSE REQUESTED IMMEDIATELY
This morning, Robin Dale sent a survey to all WHCA skilled nursing facility member administrators regarding COVID-19 testing. The state of Washington is working to coordinate COVID-19 testing for all nursing home patients and employees. Currently, there is no statewide coordinated effort to track and report that data. If you have NOT completed this two-minute online survey regarding COVID-19 testing conducted since April 1, 2020, please do so now. This information will be provided to the Department of Social and Health Services. If you have questions or need the link to the survey, please, email Lauri St. Ours.
NHSN UPDATE AND FAQs
Nursing facilities were required to submit their first set of data to NHSN by 11:59 p.m. on May 17, 2020, to be compliant with the new requirements . Facilities may choose to report more frequently, but at minimum must report at least once every seven days. The initial two-week grace period ends at 11:59 pm on May 24, 2020. Facilities that fail to begin reporting after the third week, ending at 11:59 pm on May 31, will receive a warning letter reminding them to begin reporting the required information to CDC/NHSN. For facilities who have not started reporting in the NHSN system by 11:59 pm on June 7, ending the fourth week of reporting, CMS will impose a per day (PD) CMP of $1,000 for one day for the failure to report that week. Each subsequent week that the facility fails to report will result in an additional one day PD CMP imposed at an amount increased by $500.
 
NHSN updated the instructions for the pathway forms on May 12. When completing the data collection and upload, be sure that you are using the most current instructions . You can find the new instructions on the NHSN website. During one of the NHSN data reporting webinars, the NHSN team identified that each item question must have an answer entered or it will be counted as missing data and it will be counted as not being reported. When you enter count data, even if the answer is nothing or zero, you must enter 0 in the data field. If you leave it empty, it will be flagged as "no answer."
 
According to the CDC, “to maintain consistency in reporting, if a facility is using crisis level strategies,” the facility is experiencing a shortage. “In other words, PPE strategies that do not commensurate with U.S. standards of care are considered as a shortage. For information in relation to CDC’s optimization strategies for PPE (standard, conventional, and crisis), we encourage facilities to refer to Optimize PPE Supply website.
 
A center can easily identify if they are missing data in the NSHN module by reviewing the calendar view page. Any pathway that is incomplete will be highlighted as a tan color. Pathways highlighted as green indicated all questions were answered. Missing pathway means the pathway has not been started. As of right now, NHSN does not send notices for incomplete data. Centers are encouraged to review the calendar view to ensure all four pathways are highlighted in green to ensure compliance with reporting to NHSN.
 
Centers are continuing to report a delay in being able to register and upload data to NHSN. There are also centers who are reporting significant delays in having their questions answered via NHSN help desk. Centers who are experiencing delays are encouraged to keep documentation of all attempts of contacting NHSN and any communications you have with them.
 
Some centers are reporting that they are not receiving the Agreement to Participate and Consent email. If this is happening to your center and you do not receive the Agreement to Participate and Consent in your inbox for whatever reason, you should follow these instructions: 
  1. Log-in to SAMS. 
  2. Select Long-term Care Facility Component and your facility/group name. 
  3. Click “Submit” to review the “Agreement to Participate and Consent.” 
  4. Click "Accept" next to the appropriate contact name. 
  5. Click “Submit.” A pop-up notification will appear confirming this action. 
  6. Click “ok” to acknowledge the notification. 
If you log in to SAMS and see the “Annual Survey” alert on your facility homepage, you should follow these steps to remove the alert: 
  1. On the facility homepage, click "Survey Required 2020" alert on the facility homepage to be directed to the online survey
  2. Complete the "Facility Characteristics" section and scroll to the bottom to click "save" to submit your survey. 
CARES ATTESTATION WINDOW EXTENDED, UPDATED GUIDANCE AND FINANCIAL RESOURCES
On Friday May 22, U.S. Department of Health and Human Services (HHS) extended the CARES Act Provider Relief Fund attestation window. This allows time to address additional questions and to offer providers time to collect necessary payment portal information. In the press statement , HHS announces that the attestation window and related acceptance of Terms and Conditions has been extended from 45 to 90 days from the date a provider received a payment to attest to and accept the Terms and Conditions or return the funds . Providers should have received emailed letters from HHS on Friday.

Members will need to identify the dates of each relief payment and identify their new attestation and Terms and Conditions acceptance date based on the extension. HHS updated the Fund FAQs twice this past week.

AHCA/NCAL has updated the COVID-Related Cost and Loss Calculator  and prepared a guidance document on the CARES Act Provider Relief Fund (member login required for both resources). The guidance includes: 
  • Updated AHCA/NCAL CARES Act Provider Relief Fund FAQs; 
  • A merged version of Tranches 1 and 2 Terms and Conditions with easily identifiable changes as well as a redline version of the SNF Allocation Terms and Conditions showing differences relative to the Tranches 1 and 2 Terms and Conditions. SNF Allocation has its own Terms and Conditions. Each of the three versions of the Terms and Conditions must be attested to using TINs and award dollar amounts; and 
  • A table containing key FAQs and AHCA/NCAL interpretations of HHS guidance. 
 
Questions about Award Amounts
If you have questions or concerns about Tranches 1, 2, 3 awards, contact the HHS Hotline at (866) 569-3522. HHS reported on Friday that the call center now has access to additional data and new HHS guidance to better answer questions. When calling have the following information ready: 
  • TIN(s)
  • CCN(s)
  • Dollar amount in question by tranche and by building
 
Also, if questions about Tranche 3, the SNF Allocation, also have the number of SNF certified beds (Medicare, Medicaid or both) as well as the amount you received and the amount you believe you should have received.
 
For Tranches 1 and 2, in its May 14 FAQ update, HHS provided an explanation of why a building might not have received a Tranche 2 allocation. The FAQ provides a formula and explanation of how a Tranche 1 award may have impacted eligibility for Tranche 2. See FAQs on page seven of the updated FAQ document. HHS added Change in Ownership (CHOW) FAQs as well as TIN FAQs. The latter FAQs are called out in the AHCA/NCAL Guidance document in addition to inclusion in the HHS FAQs.  
 
Next Steps – Additional CHOW, TIN, and Other Questions
AHCA/NCAL will continue to submit questions and examples of challenging fund scenarios to HHS including CHOW, TIN aggregation, disaggregation, and additional questions about financial terminology and use of tax filing data for validation. However, HHS has verbally indicated the Department’s goal is “maximum flexibility.” While we will continue work with them during the additional assentation window time, it is possible they will defer to reconciliation and reporting documentation to address all scenarios.
DOH TO HOST WEBINAR FOR HEALTHCARE PROVIDERS
The Department of Health will host its weekly webinar on Thursday, May 28, at 11:00 AM. This weekly call is designed for healthcare providers enabling them access to DOH officials and experts so they can get answers to questions and additional information to help them respond to the COVID-19 public health emergency. Register in advance , and once you register, you can save the link to join each week through May 28 as an appointment on your calendar so you will not need to search for the link each week. The password will be provided upon registration.
ADDITIONAL RESOURCES
WHCA continues to post resources and information as it becomes available on our website . If you have questions or need additional information, please call the WHCA office at (800) 562-6170.