March 28, 2020
Quick Links:
IMPORTANT NOTE:
If facilities have run out of PPE, contact your local emergency management centers. Click HERE to view the most recent directory. Please make sure this information is available to your facility's weekend management.
COVID-19 Updates: March 28, 2020

This update includes:

  • WHCA/wiCAL Calls for Immediate Action on 1135 Waivers for Wisconsin
  • LTC Leaders Address State Orders on Hospital Admissions to SNFs
  • Addressing State Orders on COVID-19 Admissions to Nursing Homes
  • Third Stimulus Package Signed into Law
  • WHCA/WiCAL Address Concerns Paid Sick Leave and Emergency FML
  • COVID-19 HUD Update
  • Trials begin for COVID-19 treatment
  • VA Update 
  • Issues with Postal Carriers and Mail Delivery 
  • Cost Report Website Available

As of today, there are 1,002 confirmed cases of COVID-19 in the state of Wisconsin and 17 deaths caused by the virus. Click HERE to view the latest outbreak information from the Wisconsin Department of Health Services.
WHCA/WiCAL Calls for Immediate Action on 1135 Waivers for Wisconsin
WHCA/WiCAL has submitted an updated 1135 emergency waiver request to CMS following news that the Wisconsin State Legislature cannot act without authorizing legislation.

Click HERE to view the letter, which the association sent with LeadingAge Wisconsin on behalf of all SNFs in the state of Wisconsin.

John Vander Meer, WHCA/WiCAL President & CEO has spoken with the offices of Sen. Ron Johnson and Sen. Tammy Baldwin calling for immediate action on the regulatory barriers to staffing. Both Senators have said they have raised the issue directly with CMS leadership on Friday afternoon.

WHCA/WiCAL learned this week that the Legislature's changes to the Governor's power that resulted Act 370 session took away the ability of a Wisconsin Governor to act on a waiver of this nature without authorizing legislation from both chambers of the State Legislature and being signed into law by the Governor.

On Friday, CMS approved an 1135 waiver request submitted by the state of Washington, which included a waiver of nurse aide hiring/competency requirements found at 42 CFR 483.35(d). WHCA/WiCAL has submitted a similar request to CMS
 
"WHCA/WiCAL believes that all states should have access to the necessary regulatory flexibility on workforce issues in this crisis," Vander Meer said. "We submitted our waiver request on April 18. It has been 10 days. We have been clearly told by CMS officials that state associations have standing to make these requests, I will continue to push on behalf of providers until Wisconsin providers receive the necessary regulatory flexibilities that they deserve in this crisis."
LTC Leaders Address State Orders on Hospital Admissions to SNFs
AHCA/NCAL reported today that Mark Parkinson, President & CEO of the American Health Care Association (AHCA) and Dr. David Gifford, Chief Medical Officer for AHCA issued the following statement addressing state orders directing nursing homes to accept all hospital patients:

“Multiple states are considering adopting an order similar to what was issued in New York that requires every nursing home to admit hospital patients who have not been tested for COVID-19 and to admit patients who have tested positive. This approach will introduce the highly contagious virus into more nursing homes. There will be more hospitalizations for nursing home residents who need ventilator care and ultimately, a higher number of deaths. Issuing such an order is a mistake and there is a better solution.

“As a former governor and a former state public health official, we completely understand the intent of the orders. Every governor and public health official are faced with the unprecedented prospect of hospitals being overrun with both COVID-19 patients and other patients who in the regular course of life need hospital care. That is already happening in Seattle, New York City and surrounding areas. No one wants a scenario where hospital beds and ventilators are unavailable and people die waiting for care. Discharging hospital patients who are well enough to be cared for elsewhere is a top priority.

“Recent data from Centers for Disease Control and Prevention found that just over half of all elderly people who tested positive for COVID-19 showed no symptoms. CDC found that these people were likely spreading the virus to others for up to seven days before they developed symptoms. This supports a ‘test before discharge’ approach in hospitals. However, lack of testing and delays in getting test results make testing patients before discharging unworkable. We need a different approach."

For details on the approach he suggests, see the full text of the statement .
Third Stimulus Package Signed into Law 
On Friday, March 27, the House passed and the President signed into law the third stimulus bill, H.R. 748, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Of particular note to skilled nursing facilities and assisted living facilities it includes the following provisions: 
  • A temporary suspension of Medicare sequestration cut 
  • $100 billion fund for eligible health care providers 
  • Deferral of 6.2% payroll tax 
  • $200 million in funding to prevent, prepare for, and respond to coronavirus 
  • Childcare support for health care sector employees 
  • New loan program for certain employers 
  • Funding for housing for the elderly and disabled 
  • Temporary relaxation of rules limiting net operating loss deductions 
  • Relaxation of excess business loss rules for passthroughs and sole proprietors. 
  • Refundable employee retention tax credit 

AHCA/NCAL has a more  detailed summary  of the bill, along with a summary of other COVID-19 related relief packages. We will be reaching out to the Administration, specifically on the $100 billion health care fund, to ensure long term care providers quickly receive a portion of these crucial resources. 
WHCA/WiCAL Voices Concerns of Providers on FML Provisions
In response to significant concerns from the provider community about Family and Medical Leave (FML) included in the Families First Coronavirus Response Act (FFCRA), WHCA/WiCAL has contacted the offices of both Sen. Ron Johnson and Sen. Tammy Baldwin, as well as the Office of U.S. Congressman Ron Kind (D-LaCrosse), who is a member of the House Ways and Means Committee. 

AHCA/NCAL will also be raising this issue Monday with U.S. Secretary Eugene Scalia, asking for him to issue guidance as soon as possible regarding the FFCRA’s “elect to exclude” mechanism.

At a minimum, WHCA/WiCAL and AHCA/NCAL believe that such guidance should confirm that, solely for purposes of the FFCRA’s paid-leave provisions, the terms “health care provider” and/or “emergency responder” include all employees of SNFs, assisted living communities, and third-party vendors providing essential services to SNFs and assisted living communities (e.g., food service providers, contract therapy companies, janitorial service providers, laundry service providers, etc.). 

More information on these measures of the FFCRA can be found in an Issue Brief recently release by The Wisconsin Legislative Council titled Paid Sick Leave and Emergency Family and Medical Leave Related to COVID-19 .

President Trump signed the FFCRA on March 18. The Act goes into effect on April 1 and is effective through December 31, 2020. 

The Act:
  • Provides for up to 80 hours of paid sick leave for an employee affected by the public health emergency.
  • Part-time employees may use the number of hours the employee works, on average, over a two-week work period.
  • If an employee is unable to work or telework, they may first use the paid sick leave provided in the act, before using other paid leave provided by an employer.
  • Under the Family and Medical Leave Act, an eligible employee may take up to 12 weeks of job-protected leave for certain qualifying reasons. The new Act adds lack of child care to the list of qualifying reasons for using emergency FMLA leave. The first two weeks are unpaid leave, followed by up to 10 weeks of paid leave.
  • The paid sick leave and emergency FMLA requirements apply to all private employers with fewer than 500 employees, to all state and local public employees, and to certain federal employers.
  • The emergency FMLA is available to an employee who has been an employer for at least 30 days. The paid sick leave is available to an employee regardless of how long they employee has been employed.
  • The U.S. Dept. of Labor may exclude employees who are health care providers or emergency responders. They may also exempt employers with fewer than 50 employees from providing the paid sick leave, or the emergency FMLA, for a lack of child care, if the requirements would jeopardize the viability of the business.
COVID-19 HUD Update
The Office of Healthcare Programs for the Federal Housing Administration has put together a questions and answers document for external stakeholders around Coronavirus (COVID-19) that can be found here .

Questions address such areas as whether the U.S. Department of Housing and Urban Development’s (HUD’s) Office of Healthcare Programs will cancel or postpone inspections or other site visits and in the event of a confirmed COVID-19 case at a HUD-insured facility, what steps should owners and operators take to protect residents, staff, and the community.

HUD has acknowledged long term care providers are looking for supplemental Q&As, and they are working on it daily. Please feel free to contact Dana Ritchie at dritchie@ahca.org with any HUD related questions. 
Trials Begin for COVID-19 Treatment
WHCA/WiCAL has learned through the Wisconsin Medical Society that the University of Minnesota began a clinical trial for post-exposure treatment for COVID-19 using hydroxychloroquine. Hydroxychloroquine is a known treatment for malaria, and it has been suggested in multiple outlets as a potential method for treating patients suffering from the COVID-19 virus. The trial is national in scope and seeks to enroll up to 1,500 people who have had household contact or are health care workers who have been exposed to someone with known COVID-19 disease within the past three days and presently are not ill. For additional information please click on the link above.

Other COVID-19 related trials are also underway. Earlier this week the Department of Health and Human Services announced it is funding a Phase 2/3 clinical trial for Kevzara as a potential COVID-19 treatment. In addition, the National Institutes for Health began a Phase 1 clinical trial for a potential COVID-19 vaccine at Kaiser Permanente Washington Health Research Institute in Seattle, called mRNA-1273. These trials are a part of over 100 treatments and vaccines that are currently being tested. Other trials include remdesivir, INO-4800 and avigan.
VA Referrals to SNF During COVID-19 Emergency 
Per an email to AHCA/NCAL from the Veterans Administration (VA), community care has halted non-urgent, non-emergent VA referrals to the community. Referrals for geriatrics and extended care services (including all nursing home referrals) will continue but they are being clinically reviewed based on guidance to carefully evaluate and prioritize referrals that are urgent/emergent and medically necessary based on clinical triage.

NOTE: The VA and TriWest have delayed the deployment of community care network throughout Region 4; Montana and Eastern Colorado will deploy June 8, 2020 and the remainder of Region 4 by August 31, 2020. Referrals in these regions for post-acute care would continue to be via local VA contracts or veterans care agreements. 

The following are useful web links to access updated VA information. 
  • The VA provider latest news webpage is here
  • The VA COVID-19 webpage is here
  • The Optum CCN Network COVID-19 webpage is here.  
  • The TriWest Network provider webpage is here.
COVID-19 and Issues with Postal Carriers and Mail Delivery
In conjunction AHCA/NCAL, we are monitoring potential issues with mail delivery during the COVID-19 pandemic. Specifically, we have been hearing that postal carriers are refusing to comply with screening process as required by CMS and many states for entrance into long term care facilities. When these issues have arisen, rather than simply adhering to the new safety protocol, postal carriers have refused to deliver the mail and/or required providers to retrieve their mail from the local post office. 

Getting mail is one of the primary ways for our residents to stay connected to loved ones as well as to continue their important everyday routines. Many also receive crucial packages, such as prescriptions and tax preparation information in the mail. Through AHCA/NCAL, we have been advocating on Capitol Hill that postal carriers be subject to the same screening process as all essential personnel to our communities. 

That being said, we have recently heard that the United States Postal Service (USPS) will be offering centers and other customers three options for mail delivery if there are issues with their current delivery. 
  1. You may opt to redirect to a temporary mail receptacle inside or outside the building where screening would not be necessary. 
  2. Place the mail on hold at the Post Office servicing this delivery. Mail and parcels can be held up to 30 days and will be available for customer pickup. 
  3. Redirect all mail for the business to an alternate location. 

Please note that in addition to the Capitol Hill efforts around this issue, AHCA/NCAL joined forces with other national associations to send a  letter  to the Postmaster General and Chief Executive Officer of the U.S. Postal Service to express our concerns. AHCA/NCAL will continue to monitor this issue, and keep us apprised of any relevant updates. 

For additional questions, please email 

For more information and resources:
Cost Report Website Available
When the University of Wisconsin closed the Center for Health Systems Research Analysis (CHSRA) in June 2019, nursing home rate-setting data warehousing and analytics transitioned to Forward Data Analytic Services, LLC (FDAS), comprised of former CHSRA employees. The online cost reporting platform "ORBS" was temporarily shut down as a result of the closure, however, FDAS has now re-opened "ORBS" at a new url: https://orbs.fdasllc.com/ .

If you were a previous user of the former ORBS platform, please use the "Forgot my password" link on the new platform to set a new password. While user accounts have transitioned to the new platform, passwords did not transition for security purposes. If you have forgotten your username there is also a link on the new platform to recover it with an email address.
If you are a submitter of cost reports for a facility that did not have an account on the old platform, you may register for a new account.

User Login Help
The website has a new "Help" email address: orbshelp@fdasllc.com . Please include your first and last name, contact phone number, email address, nursing facility name, and POP ID number (or, if applicable, accounting organization or chain affiliation) when contacting ORBS Help .

Cost Report Deadlines
Many facilities have submitted 2019 cost reports via email during the period when "ORBS" was shut down. No action is required by these facilities at this time.
Facilities with a calendar year end who have not yet submitted a 2019 cost report should submit via the new platform effective immediately.

The cost report deadline of May 31, 2020 for calendar year-end filers has not changed. If you need additional time to complete your cost report due to the COVID-19 crisis, please communicate the date you plan to complete it to your regional auditor. Later submissions may result in later finalized rates, but no formal enforcement actions are planned at this time.
WHCA/WiCAL Staff
As a reminder, WHCA/WiCAL's staff team is ready to serve your facility. We are committed to providing members with the services you need to succeed in your mission to provide high-quality care to Wisconsin's most vulnerable residents.
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 | kate@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

WHCA/WiCAL | 608.257.0125 | info@whcawical.org | www.whcawical.org