Coronavirus Update #20
Second Call with Hospital Partners, Plus Additional Guidance
Second HFAM & Hospital Partner Call - Monday, March 23 at 4:00 PM

Along with the Maryland Hospital Association (MHA), the University of Maryland Medical System (UMMS), Johns Hopkins Medicine, LifeBridge, and other hospital partners, HFAM will be hosting our second call to connect our sectors. HFAM will invite broadly and work with partners and other associations to make all post-acute providers aware of this call.

The purpose of that call will be to discuss topics of mutual interest such as transfers between hospitals and post-acute facilities, telehealth, and any other priorities amid the COVID-19 pandemic.

This call will take place Monday, March 23 at 4:00 PM EST
 
Dial-in: +1-415-655-0001
Passcode: 316 561 900 #
Recap of HFAM Call with Majority Leader Hoyer

This morning, at the request of AHCA/NCAL, HFAM had a phone conversation with U.S. House of Representatives Majority Leader Steny Hoyer to report from the front lines of the COVID-19 pandemic here in Maryland. Leader Hoyer and his team are fully engaged in this historic and unprecedented crisis.

We discussed issues concerning workforce, PPE, testing, cost, revenue, and regulatory challenges that the long-term and post-acute care sector is facing during this crisis, as well as the critical steps Maryland is making to prepare for the anticipated care surge.

In addition to the FMAP increase legislation that was enacted yesterday (more on that below), please know that AHCA/NCAL is seeking additional relief for our sector during this crisis. AHCA/NCAL and HFAM have an important and powerful partnership during these especially difficult times.
As a reminder, we continue to advise:

  • The #1 action you and your teams can do right now is keep all non-essential people out of your centers.

  • Employees simply cannot come to work if they are symptomatic.

  • Be prepared to over-communicate with staff, residents, patients, and families.

  • Inventory supplies and medication - especially infectious control gear.

  • Review your policies and training.

  • Closely monitor the health of your patients, residents, and staff.

  • Establish lines of communication with your hospital partners, local and state health officials.
PPE Updates & Reminders

The Centers for Disease Control and Prevention (CDC)  issued new guidance today on the use of masks, gowns, and face shields including suggestions on what to do if in crises shortages and when your supplies are exhausted. AHCA/NCAL released an informative alert summarizing this new guidance.  Click here to view the full AHCA/NCAL alert.

As a reminder:

  1. Your first step for help is to call the local health department where your SNF is located.
  2. Everyone is short, but still ask your neighbors and partner hospitals.
  3. Finally, this is the email to the state to tell them you have PPE supply issues in advance: sns.mdh@maryland.gov
Telehealth Guidance

Yesterday,  CMS expanded telehealth for Medicare  . Medicare will temporarily pay clinicians to provide telehealth services for beneficiaries for a wider range of services. CMS Under the new waiver, Medicare can pay for office, hospital, and other telehealth visits. For the duration of the COVID-19 Public health Emergency, Medicare will make payment for professional services to beneficiaries in all areas of the country in all settings.  

Be prepared to utilize telehealth in advance of the incoming surge. We strongly recommend your center prepare equipment and processes for Skype/Facetime/videoconferencing -- especially for your physicians, PAs, and RNs.
Reminder: Videos & FAQs

The Maryland Department of Health and Maryland Department of Aging have developed a series of audio and video messages directed at seniors on a variety of topics related to the current COVID-19 pandemic. Please use these materials to help communicate with residents.

Topics include:
  • Use of the dining hall
  • Home sanitation
  • Senior Call Check-in
  • Senior center closings
  • How to keep informed

Possible uses for these materials include:
  • Closed circuit television
  • Lobby screens
  • Social media platforms
  • E-newsletters
If you have questions about how to use the materials, please contact  pio.mema@maryland.gov .
Relief Package Passes the Senate, Signed by the President 

Last night, the United States Senate passed and the President signed into law H.R. 6201, the Families First Coronavirus Response Act. Within our sector, the bill provides temporary 6.2% increase in Federal Medical Assistance Percentages (FMAP). This will allow for state Medicaid programs to have the funding needed to ensure that the most vulnerable patients and residents have continued quality care during the COVID-19 pandemic. 

This bill also includes other provisions like free coronavirus testing, expanded food and unemployment assistance and paid sick leave. There are numerous questions about how these additional provisions will be implemented and what they mean for employers. Please be on the lookout for additional information and a more detailed summary of this legislation.
CMS National Webinar Yesterday (March 18th) Postponed 

Due to technical difficulties with their phone lines, the CMS national webinar for LTC was cancelled and will be rescheduled. The new date and time has not been announced yet, please be on the lookout for more details once the call is rescheduled.

As a reminder, CMS will continue to hold future calls and post those transcripts and audio recordings as they become available. To access recorded COVID-19 Stakeholder calls click HERE    
CDC Guidance on When HCP Can Return to Work 

There have been questions among providers regarding when a staff member who is staying home because of fever or respiratory symptoms can return to work. CDC posted  guidance  from March 16, 2020 on criteria for return to work. Use one of the below strategies to determine when health care personnel (HCP) may return to work in health care settings: 

Non-test-based strategy.  Exclude from work until: 
  • At least 3 days (72 hours) have passed since recovery, defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and, 
  •  At least 7 days have passed since symptoms first appeared 

Test-based strategy, if tests are available.  Exclude from work until: 
  • Resolution of fever without the use of fever-reducing medications and 
  • Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
  • Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens) 

If HCP were never tested for COVID-19 but have an alternate diagnosis (e.g., tested positive for influenza), criteria for return to work should be based on that diagnosis. 
AHCA/NCAL Guidance on Therapy Services During COVID-19 

This  document   provides guidance for therapists on how LTC Facilities (SNFs and ALs) can operationalize federal and state guidance to significantly restrict visitors and non-essential personnel, as well as restrict communal activities inside LTC facilities as part of the effort to prevent COVID-19 from spreading. When deciding if a therapist needs to enter a building (regardless of their being an employee or outside contractor), we advise LTCs to consider the intent of the federal and state guidance in deciding. The intent is to restrict entry of as many people as possible, as each additional person entering increases the risk of COVID-19 entering. 
 
Of course, this also needs to be balanced with trying to meet the needs of the resident. That risk-benefit trade off needs to be made on a case-by-case basis but should incorporate the high morbidity and mortality associated with contracting this virus in the elderly over 80 (estimated at 15-20% or more). 
Pharmacy and Pharmacists Procedures During COVID-19 Outbreak 

Nursing facilities, assisted living communities and pharmacies should work together to ensure appropriate access to the facilities and to medical records so that pharmacists and pharmacy personnel can continue to provide essential services to their residents while adhering to guidance on restricting entry to the building to only essential personnel. 

There is currently no waiver in the requirements of participation for skilled nursing facilities in Medicare/Medicaid related to a pharmacist’s review. A pharmacist or pharmacy personnel must still be able to perform functions such as drug replenishment, controlled drug security/destruction, refilling electronic cabinets/eKits, and medication regimen review (MRR). 

MRR reviews and some other pharmacy related duties can be performed remotely when possible, as long as the pharmacist has access to the full medical record. This may involve access to multiple electronic systems or a sequestered room within a facility (paper charts). Other emergency procedures include making deliveries dropped off at a dedicated location, such as a loading dock or secure area outside. 

If a pharmacist or pharmacy staff need to enter the nursing facility or assisted living building to perform regulatory-required services, the pharmacy staff must follow appropriate screening and PPE procedures. 
Did you miss HFAM's previous alerts?

Visit our website to view all previous HFAM alerts, as well as guidance
from our federal and state partners.
Please email COVID19@ahca.org for additional questions, and visit
www.ahcancal.org/coronavirus for additional information and resources.
Thank you.

We cannot thank you enough for the dedication and diligence in doing all that you can for the residents in your communities. HFAM continues to monitor the COVID-19 pandemic with our state and national partners and will do all we can to support you during this time.