COVID-19 UPDATE #231
March 2, 2022
BIDEN TARGETS 'WALL STREET' NURSING HOME OWNERS IN SOTU
President Biden delivered the State of the Union address last evening, and nursing homes were on the receiving end of much criticism. McKnights Long-Term Care News reported this morning, "Just over halfway into his 62-minute address before Congress, Biden vowed to crack down on private-equity owners of nursing facilities. He also said nursing homes will be subject to tougher Medicare oversight, something the White House unveiled in a sprawling reform brief Monday."

The article summarizes the "crackdown" the Biden administration has planned for nursing home operators and includes commentary from the American Health Care Association, "Calls for increased government scrutiny, regulations and fines do not recognize the nature of COVID-19 and how public health officials failed to prioritize nursing homes for resources before and during the pandemic,” said Beth Martino, Senior Vice President of Public Affairs for the American Health Care Association/National Center for Assisted Living, in a statement emailed to McKnight’s after the State of the Union address.
HAPPENING THIS FRIDAY: AHCA/NCAL POST-STATE OF THE UNION MEMBER WEBINAR
All WHCA members are invited to join President & CEO Mark Parkinson and the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) team for a member webinar this Friday, March 4, at 10 AM PST to discuss the details of President Biden’s proposals for nursing homes presented during the State of the Union address and the Association’s response. 

Registration is required, and the webinar is available to all AHCA/NCAL members. It will be recorded. All registrants will be notified by email when the recording is available. 
CMS NURSING HOME STAKEHOLDER CALL TO FOCUS ON ADMINISTRATION'S VISION FOR NURSING HOMES
CMS has announced that the next National Nursing Home Stakeholder Call to be held on March 10 at 12 PM PST will further outline the details of the Biden Administration’s nursing home vision. CMS shared that the implementation strategy will be through these national stakeholder calls, list serves, and collaboration with residents, families, providers, and other stakeholders. 

CMS will discuss the vision, including “setting minimum staffing requirements, enhancing oversight and accountability, and making facility ownership more transparent so that potential residents and their loved ones can make informed decisions about care.” CMS will also be establishing a list serve to provide information and updates on this vision.

More information on the vision is available in this White House Fact Sheet, and details about the call will be shared as they become available. 
DEAR ADMINISTRATOR LETTER PROVIDES INSIGHT ON INTERIM FINAL RULE - OMNIBUS COVID-19 HEALTH CARE STAFF VACCINATION
In a Dear Administrator letter dated February 18, 2022, skilled nursing providers were reminded of the Centers for Medicare and Medicaid Services (CMS) rules regarding the federal vaccine mandate. The letter specifically explains that the federal vaccine mandate and the Washington State mandate vary in two ways:

  1. CMS requirements allow staff to start work before being fully vaccinated. Staff must have proof of having received the single dose of the Johnson and Johnson vaccine, or having the first dose and scheduled appointment for the second dose of the Moderna or Pfizer vaccine before being hired. It also requires staff to have an approved or pending exemption request (reasonable accommodation). Proclamation 21-14 has a more stringent requirement for all long term care staff to be fully vaccinated prior to employment unless a reasonable accommodation has been approved. In both proclamation 21-14 and CMS requirements, fully vaccinated does not include booster vaccinations.
  2. Both Washington State proclamation requirements and CMS requirements direct the provider to verify vaccination status of facility staff. Under Washington State Guidance, providers were required to document this verification occurred and document which staff were fully vaccinated. CMS requires provider documentation of the type of vaccine given; the date of the first, and when applicable, the date of the second dose of vaccine; and if a booster was given, the date of the booster vaccination. If a provider did not gather this level of detail as a part of the Washington State vaccine mandate, they will need to gather this information to meet the CMS requirement. Effective January 27, 2022, RCS survey staff began following the CMS standard for verification of vaccination status. 

If you have questions on the vaccine mandate related to skilled nursing facilities, please email Molly McClintock, Nursing Home Policy Program Manager, or call her at (360)a742-6966.
AHCA RELEASES REPORT HIGHLIGHTING UNPRECEDENTED ECONOMIC CRISIS IN NURSING HOMES
The American Health Care Association (AHCA) today released a new report outlining the financial impact of the COVID-19 pandemic on the nation’s nursing homes. The report, produced by CLA (CliftonLarsonAllen LLP), highlights that the cost of care and other operations in nursing homes is far exceeding their reimbursement rates, resulting in a projected 4.8 percent negative margin. The industry is also facing a historic workforce crisis and significant declines in occupancy as a result of the pandemic. The unprecedented challenges have resulted in reduced access to care for seniors and individuals with disabilities across the country.

Key findings from the report include:
  • Increasing Costs Due to Labor and Inflation: The CLA report found that average increase in wages for nurses at all levels doubled from 2020 to 2021. Rates for contracted and agency nurses are also two to three times higher than pre-pandemic rates.
  • ​Negative Margins: CLA projects the median 2022 year-end operating margin to be -4.8 percent with a median occupancy of 77.3 percent. This projection is based on maintaining the current Patient-Driven Payment Model through Medicare and state public health emergency (PHE) funding levels. The CLA report emphasizes that any reduction in reimbursement could deepen financial issues for the long term care sector.
  • Increased Risk for Closures: The CLA report found that 32 to 40 percent of residents (as many as 417,000 residents) are currently living in nursing homes that are considered financially “at risk” – including buildings with Five-Star quality ratings.
  • Challenges with Access to Capital: Medicare margins and PHE related funding provided help and support throughout 2020 and early 2021, but potential cuts to these programs pose risk to nursing homes as they continue to face financial challenges such as occupancy decline, staffing shortages, and increased labor costs.

“When you look at the big picture and everything that nursing homes are facing both pre-pandemic and today, it’s a major cause for concern,” said AHCA President and CEO Mark Parkinson. “When nursing homes struggle to stay afloat, it is our vulnerable residents who need around-the-clock care that ultimately lose. Long term care needs government resources to address staffing shortages and ensure access to care for our nation’s seniors. That means we require immediate assistance to respond to the current crisis, and we must have a stable and sustainable reimbursement system moving forward.”

Parkinson recently sent a letter to Congressional leadership, requesting that federal lawmakers replenish the Provider Relief Fund with $20 billion allocated to the long term care sector. The fund has been depleted, but only aided providers through the end of the first quarter of 2021, despite new COVID variants—Delta and Omicron—causing havoc on the nation’s health care systems last year and in early 2022.

“This report is a comprehensive view of the current financial state of the nursing home industry,” said Deb Emerson, Principal at CLA. “You cannot simply look at one piece of the puzzle, such as Medicare payments. Inflation, labor costs, COVID resources – all of these have a significant impact on the ability of nursing homes to continue providing care to their patients every day.”

The full CLA report is available here.
VACCINATION TRACKING AND REPORTING TOOLS FOR SNFs
The Agency for Healthcare Research and Quality (AHRQ) wants to make it easy for nursing homes and skilled nursing facilities to track and report COVID-19 vaccination information. You can find free, one-page forms to record vaccinations and boosters for nursing home residents and staff along with a vaccination tracking tool and a user-guide with step-by-step instructions for using the tracking tool. Facilities reporting data to CDC's National Healthcare Safety Network (NHSN) can use a pre-programmed Excel workbook. Detailed instructions explain how to enter the data electronically or as a paper tool at the time of injection. Use these tools to update your electronic medical records, respond to potential vaccine data requests from local health departments or other regulatory agencies, and plan based on the vaccination administration status and rates of both residents and staff. These tools are part of AHRQ’s ever-growing Nursing Home COVID-19 Resource Collection. 
DOH PROVIDES UPDATED GUIDANCE
The Department of Health (DOH) continues to update its guidance documents to align with CDC recommendations and national guidelines. Recently, they have made updates to the following:

  • Updated to reflect that residents not up to date with COVID-19 vaccines that are newly admitted should quarantine for 10 days or 7 days with a negative test
  • Updated to no longer recommend pausing admission as long as the LTCF can safely admit and the resident (POA/guardian) is made aware of the COVID status in the facility

  • Updated to align with CSTE/COHRA outbreak definition

  • Updated to align with CDC removal of language indicating that facemask is acceptable alternative to respirator when caring for patients with COVID-19. Use of facemask for care of patients with COVID-19 is still included as a crisis capacity strategy for N95. 

  • Updated to reflect that visitors should not visit healthcare facilities until 10 days from COVID-19 illness
  • Updated to reflect that visitors not up to date with COVID-19 vaccines should not visit healthcare facilities until 10 days from COVID exposure, or 7 days with a negative test
ADMISSION INCENTIVES FOR AL AND SNF THROUGH MARCH 31
In a Dear Administrator letter to assisted living providers and one to skilled nursing providers, the Department of Social and Health Services relates that Home and Community Services (HCS) received approval to extend admission incentives to both assisted living and skilled nursing centers that accept new resident admissions from acute hospitals through March 31, 2022. These letters amend the Dear Provider letters originally sent August 12, 2021 (AL) and August 9, 2021 (SNF).
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.