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Virtual Spring Conference Live Session Schedule:
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May 8th, 10 -11 AM: Employment Issues during COVID-19 Pandemic; Presenter: Doris Bronsan of von Briesen & Roper
Don’t worry, if you are unable to attend a live session, it will be recorded and added as an on-demand session, that you may view in accordance with your own schedule.
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COVID-19 Updates: May 7, 2020
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This update includes:
- DHS Announces Plan to Publicly Disclose COVID-Confirmed Cases in Nursing Homes
- CMS Releases Memo on Interim Final Rule Updating Requirements for Reporting and Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes
- DHS Outlines Process for Statewide Nursing Home COVID Testing
- DHHS Extends Attestation Window for CARES Act Provider Relief Fund
- ForwardHealth Update "Approval of Nursing Home Levels of Care During COVID-19" Revised
- May 7, 2020: Electronic Visit Verification Webpage Added
- Bureau of Assisted Living Regulatory Response to COVID-19 – Assisted Living Forum Tuesday, May 12, 2020
- Upcoming Medline Webinar! Emergency Preparedness: Skin Health Practices Simplified
- State Unemployment Fund Could Run Out by October; $870 Million Drop in State Tax Collections
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As of today, there are 9,215 confirmed cases of COVID-19 in the state of Wisconsin and 374 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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DHS Announces Plan to Publicly Disclose COVID-Confirmed Cases in Nursing Homes
WHCA/WiCAL has voiced provider concerns with resident privacy, facility stigma
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Lisa Olson, DHS Assistant Deputy Secretary, today joined the regularly-scheduled Thursday 11 am DQA-SNF Provider Call to announce that starting Monday, May 11, DHS will publish on its website a list of nursing homes in Wisconsin which currently have a confirmed case of COVID.
DHS had hinted to WHCA/WiCAL earlier this week that they were moving in this direction, and WHCA/WiCAL President & CEO sent a
letter to Governor Evers and DHS Secretary-Designee Palm expressing significant concerns with the proposed policy, raising questions about the process, and offering suggestions if DHS decides to move forward regardless of provider concerns. See more on the letter below.
Details of New Public Disclosure Policy Start to Emerge
The following notes are from the DHS announcement, although specifics are not available at this time. This information is subject to change as more information is published by DHS.
- The public posting will include a lag time of about 48 hours, which should allow facilities time to notify residents and families before the information becomes public.
- The disclosure will only state whether a facility has a current confirmed COVID-positive case in the facility, and will not provide number of cases at a facility.
- This disclosure will include positive cases for either employees or residents, but the information will not identify whether it is a resident or staff.
- DHS will not disclose COVID-positive cases in nursing homes with fewer than 10 residents.
- Just as there is a trigger to be added to the list (COVID-positive test for a resident or employee), there will be a trigger to be removed from the list (presumably confirmation that there are no current COVID-confirmed individuals at the facility, but the details of this have not been made public).
- As of now, this public disclosure will be limited to nursing homes, not assisted living (or other health settings like hospitals).
Provider Associations Raise Concerns in Advance of Announcement
On Wednesday, May 6, WHCA/WiCAL and LeadingAge WI sent a
joint letter to Governor Evers and DHS Secretary-Designee Palm expressing concern with the proposed disclosure policy.
Concerns raised in the letter included:
- A lack of provider input before the decision was made to create this new disclosure policy
- Resident privacy issues
- Unfairly targets nursing homes and does not include other health settings
- The public naming of COVID-positive facilities is a de facto public shaming of these facilities
- Facilities will be more reluctant to accept new admissions from hospitals for fear of a stigma associated with having COVID in the building
- There is a lack of a compelling public health interest for this proposed policy
The associations noted that if the proposal does move forward despite provider concerns, DHS should take several factors into consideration:
- The public posting website should include a prefatory statement that a facility's COVID status is not an indication of quality of care provided
- The disclosure should not identify whether the case is an employee or resident, for privacy reasons
- If this policy is going to move forward, it should not just include nursing homes
- There should be at least 48 hours lag time between COVID confirmation and public disclosure, so facilities have proper time to communicate to residents and families before the information is public
- Providers would prefer one weekly update rather than a daily update, as a daily update will allow stories of COVID in nursing homes to be in the press daily
- If there is a trigger to be added to the list, there should also be a trigger to be removed (i.e., no current COVID cases at the facility)
- There should be a special designation for facilities which have created dedicated COVID units/wings to help treat confirmed patients.
The letter also discussed providers' ongoing request to have additional state funding to help nursing homes deal with the extra costs associated with preventing/minimizing COVID in a building. If the department is going to publicly name facilities with COVID, then the state should also be helping to reduce spread through adequate resources for facilities. The letter discussed the current financial insecurity of many facilities, and emphasized that the COVID crisis has made financial situations worse, requiring state assistance.
WHCA/WiCAL will continue to work with members, stakeholders, and the Department to make this policy as unobtrusive as is possible. Look for additional updates in WHCA/WiCAL's COVID update communications.
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CMS Releases Memo on Interim Final Rule Updating Requirements for Reporting and Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes
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Late yesterday, CMS released a
QSO memo addressing the Interim Final Rule requiring nursing homes to report to NHSN on COVID-19 as well as provide notifications to residents, their representatives and families.
Some highlights from the memo are listed below. AHCA is reviewing the information and will issue additional updates with further details and tools to help members comply. There are some important implementation dates members need to know.
These requirements go into effect with the publication in the Federal Register of the
interim final rule
on May 8, 2020.
CMS had previously communicated the effective date was May 1. However, CMS revised the effective date to be May 8, 2020.
- The effective date means nursing homes are required to begin notifications of residents, their representatives and families as of May 8. This means the first notification could be required to occur by May 9 at 5 pm, should the facility have any of the resident and/or staff cases on May 8 as described by CMS required to make notification.
- Action: Ensure system and processes for notifications are in place in your facility by May 8 to meet new requirements.
Facilities must submit their first set of data by 11:59 pm on Sunday, May 17, 2020 to the NHSN Long-Term Care Facility COVID-19 Module.
- Action: Register now for NHSN and begin collecting data starting May 8, 2020. [NOTE: registration is taking more time than expected and we encourage you to start now to avoid further delays that may impact your compliance.]
- The memo provides an overview of the registration process.
- For NHSN questions, please email: NHSN@cdc.gov and add “LTCF” in the subject header.
CMS will provide facilities with an initial two-week grace period to begin reporting cases in the NHSN system (which ends at 11:59 p.m. on May 24, 2020). Facilities that do not begin reporting after the third week (by 11:59 pm on May 31, 2020) will receive a warning letter reminding them to begin reporting the required information to the CDC.
For facilities that have not started reporting in the NHSN system by 11:59 p.m. on June 7, ending the fourth week of reporting, CMS will impose a per day (PD) CMP of $1,000 for the failure to report that week.
For each subsequent week that the facility fails to submit the required report, the noncompliance will result in an additional one-day PD CMP imposed at an amount increased by $500.
New COVID-19 F-tags & Updated Survey Tools
CMS has established two new F-Tags - F884: COVID-19 Reporting to CDC and F885 COVID-19 Reporting to Residents, their Representatives, and Families.
CMS has updated survey tools including COVID-19 Focused Survey for Nursing Homes, Entrance Conference Worksheet, COVID-19 Focused Survey Protocol, and Summary of the COVID-19 Focused Survey for Nursing Homes. These updated forms are posted to the
Survey Resources folder
in the COVID-19 Focused Survey sub-folder on the CMS Nursing Homes website.
- Action: Facilities should begin using the revised “COVID-19 Focused Survey for Nursing Homes” to perform their self-assessment. Surveyors will begin using these revised documents immediately.
Public Posting of NHSN Data Anticipated By End of May
CMS anticipates publicly posting CDC’s NHSN data (including facility names, number of COVID-19 suspected and confirmed cases, deaths, and other data as determined appropriate) weekly on Monday’s at
https://data.cms.gov/
by the end of May.
Multiple Q&A
CMS provides 22 Q&A in the last 7 pages of the memo. Question 10 addresses retrospective reporting and reads as below:
- Q: Are facilities required to report data that predates the effective date (May 8) of the interim final rule?
- A: No, there is no requirement in the rule to collect older data.
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DHS Outlines Process for Statewide Nursing Home COVID Testing
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On Monday, Governor Evers announced testing for all residents and staff in every nursing home in Wisconsin during the month of May. Today during the DQA-SNF call, Amanda Dreyer, Division of Enterprise Services, and Chuck Warzeca from the EOC reviewed the purpose and process for the testing which is already rolling out. First, Dreyer said that the purpose of this project was to keep people safe. Facilities and residents do have a choice of not doing the testing. The process includes having informed consent, including what it means if you decline. Exact Sciences of Madison is supplying the tests and is conducing the lab testing. They will deliver the supply for testing, help facilities understand the process to collect, and a courier will transport the specimen for testing in Madison.
Facilities will need a provider order; the suggestion is that your Medical Director could order the testing. You can request assistance with collecting the test if you do not have staff trained or available to conduct the swab collection; otherwise, it is recommended to complete the testing with trained on-site staff to avoid allowing new persons into your facility.
This test is the Molecular testing PCR test, which they stated is very accurate and involves a nasal swab, not the more invasive nasal/pharyngeal test. Testing will start in the areas of the state that need and want the test and then the state will stagger testing so that they are not in the same community all at once. This process allows for a lesser degree of PPE usage and a more comfortable process for staff and residents.
It is up to the facility if they test in one day or over a few days. If the facility is interested, they can contact DPH with request for supplies. Facility should still follow current guidance of contacting the health department with symptomatic staff or residents. DPH is aware that testing in one or two days will only be testing a point in time. The purpose is to look for non-symptomatic positive residents. It is unknown at this time what the protocol will be for retesting. Information will be forthcoming. This testing is only for Nursing Facilities. Assisted living facilities are not part of the 1
st round of testing.
Once the swabs are received in Madison, DHS officials projected that facilities will have results within 48 hours.
Dreyer stressed that their intent was not to create a stigma but to use as a tool for enhancement of processes. The website for requesting testing supplies or services is
covid19supplies.wi.gov. The testing is being provided by the State with
no charge to facilities.
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DHHS Extends Attestation Window for CARES Act Provider Relief Fund
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Earlier this week, U.S. Department of Health and Human Services (DHHS) noted that if the Department was unable to prepare updated FAQs and new guidance for fund recipients, the CARES Act Provider Relief Fund attestation window would be extended. In the early release press statement below (HHS Extends Deadline for Attestation, Acceptance of Terms and Conditions for Provider Relief Fund Payments to 45 Days), DHHS announces that the attestation window and related acceptance of Terms and Conditions has been extended by 45 days, formerly 30 days,
from the date a provider received a payment to attest to and accept the Terms and Conditions or return the funds.
Members will need to identify the date of their initial funding relief payment and identify their new attestation and Terms and Conditions acceptance date based on the extension. Below, DHHS offers an example of how the extension of the window will be operationalized.
Next Steps
AHCA/NCAL will continue to submit questions and examples of challenging fund scenarios to DHHS including Change in Ownership (CHOW), Tax Identification Number (TIN) aggregation, disaggregation, or lack of TIN arrangements, additional questions about financial terminology and use of tax filing data for validation. If you have questions for submission to DHHS, please submit your requests to
COVID19@ahca.org.
HHS Extends Deadline for Attestation, Acceptance of Terms and Conditions for Provider Relief Fund Payments to 45 Days
The Department of Health and Human Services has extended the deadline for healthcare providers to attest to receipt of payments from the Provider Relief Fund and accept the
Terms and Conditions. Providers will now have 45 days, increased from 30 days, from the date they receive a payment to attest and accept the Terms and Conditions or return the funds. As an example, the initial 30-day deadline for providers who received payment on April 10, 2020, is extended to May 24 from May 9, 2020. With the extension, not returning the payment within 45 days of receipt of payment will be viewed as acceptance of the Terms and Conditions.
President Trump is providing support to healthcare providers fighting the COVID-19 pandemic through the bipartisan CARES Act and Paycheck Protection Program and Health Care Enhancement Act which provide $175 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. This funding will be used to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured Americans can get treatment for COVID-19.
In allocating the funds, the Administration is working, among other things, to address both the economic harm across the entire healthcare system due to the stoppage of elective procedures, and addressing the economic impact on providers particularly impacted by COVID-19, and to do so as quickly and transparently as possible.
Visit
hhs.gov/providerrelief for more information on the allocations. Recipients of payments from any of these allocations must attest and accept the Terms and Conditions within 45 days.
HHS is distributing $50 billion across the healthcare system to providers and facilities that bill Medicare.
Recognizing the financial strain from COVID-19 inpatient admissions, HHS is distributing $12 billion to hospitals that reported at least 100 COVID-19 inpatient admissions through April 10 to HHS.
HHS is distributing $10 billion to rural hospitals and clinics.
HHS is distributing $400 million to tribal healthcare providers.
HHS is using a portion of the Provider Relief Fund to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured.
HHS is working to provide relief to additional healthcare providers including skilled nursing facilities, dentists, and other providers significantly impacted by COVID-19.
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ForwardHealth Update "Approval of Nursing Home Levels of Care During COVID-19" Revised
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Effective immediately and for the duration of the public health emergency related to COVID-19, ForwardHealth will grant all submitted nursing home level of care determination forms for dates of service on and after March 1, 2020. These changes are issued in response to COVID-19 pursuant to section 1135 of the Social Security Act waiver of 42 C.F.R. § 483.20 on a “blanket” basis determined by the federal Centers for Medicare & Medicaid Services. As a result, these changes are in effect with a retroactive date of March 1, 2020, through the end of the national public health emergency, including any extensions. ForwardHealth will publish additional guidance about the topics addressed in this ForwardHealth Update when the temporary policies related to COVID-19 expire.
Facilities are still required to submit the Nursing Home Care Determination Request form, F-01020 (07/2018), for a level of care to become effective. Facilities are reminded that when a member is discharged, the level of care determination form must be submitted to ForwardHealth with an end date. End-dating levels of care is critical to ensure that discharged members have access to other services.
Please see the update for more details.
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May 7, 2020: Electronic Visit Verification Webpage Added
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The Wisconsin Department of Health Services (DHS) has added a new Electronic Visit Verification webpage:
Alternate EVV.
This page includes business requirements and technical specifications for provider agencies who would like to use an EVV system other than the DHS-provided one.
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Bureau of Assisted Living Regulatory Response to COVID-19 – Assisted Living Forum Tuesday, May 12, 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.
The Assisted Living Forums will be changed next week to be only on Tuesday, 10 – 11:30 am. Assisted living providers and stakeholders may submit questions to be addressed by completing a survey on the DQABAL webinar invite no later than 4 p.m. the Friday before the forum.
This session is conducted on Tuesdays from 10:00-11:30 a.m. until further notice. Please join on Tuesday, May 12, 2020.
To Join:
Meeting ID: 723 961 504
Or by Phone: +1 312 626 6799
This week’s forums mostly answered questions that were repeats from previous forums. The recorded forums can be found
HERE.
- Closely Monitor Residents for COVID-19
- PPE Lessons
- Sparkling Surfaces: Stop COVID-19s Spread
- Keep COVID-19s Out!
- Clean Hands – Combat COVID-19
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Upcoming Medline Webinar! Emergency Preparedness: Skin Health Practices Simplified
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When: Friday, May 8, 11:00 a.m. CST
Please join WHCA/WiCAL Gold Business Partner, Medline, for a webinar tomorrow to learn about a simplified, yet effective systematic strategy for both prevention and treatment of risk factors for existing wounds, skin appearance and skin conditions. Tools for the bedside clinician, caregivers, family, and providers will be presented.
Presenters:
Joanne Labiak, MSN, CRNP, CWOCN, CWS, FAPWCA
Tom Clopp, BSEd, MSEd, Vice President of National Accounts – Skin Health
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State Unemployment Fund Could Run Out by October; $870 Million Drop in State Tax Collections
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A new analysis shows Wisconsin's unemployment insurance fund could be depleted by October if the state's high rate of joblessness — caused by efforts to clamp down on the spread of COVID-19 — continues at its current pace.
While the Department of Workforce Development, which is experiencing an unprecedented 300,000-plus claims per week, can borrow from the federal government if the Unemployment Insurance Trust Fund is exhausted, the news adds to mounting pressure from Republican lawmakers calling for a regional reopening of the state's economy.
The fund,which sat at more than $1.8 billion Wednesday, would last until Jan. 3 if payable claims drop to 170,000 per week and, if weekly payable claims were reduced to 85,000, the fund would be depleted by Sept. 19, 2021.
"At this time we do not anticipate running out of funds to pay benefits, but in the event that the Trust Fund does go negative, we will borrow funds from the federal government, as we did during the Great Recession, so much needed UI benefits continue to make it into the hands of working people and families," said Department of Workforce Development Secretary Caleb Frostman said in a statement.
The nonpartisan Legislative Fiscal Bureau found state tax collections from July 2019 through last month were $313 million lower than the same 10-month span in the last fiscal year.
The bureau reports that April’s reduction can be due in part to the extension deadlines for filing income and franchise taxes from April to July this year. But it also noted that “the coronavirus pandemic has severely impacted the state’s economy and tax collections.”
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Pat Boyer, MSM, RN, NHA
| Director of Quality Advancement and Education |
pat@whcawical.org
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