Coronavirus Update #41
Updates from Governor Hogan, CMS, and Additional Guidance
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Governor Hogan Update
Governor Hogan and his team today held a
press conference that included important messages for skilled nursing and rehabilitation centers and assisted living communities across Maryland.
Maryland Department of Health Deputy Secretary Fran Phillips, who has been heroically leading Maryland’s fight against COVID-19, made extensive remarks about our sector and the current community surge of the virus.
Deputy Secretary Phillips stated the following regarding our sector:
- Reassured residents and families that the State of Maryland is working 24/7 for them, and to keep residents safe.
- Thanked front line skilled nursing and rehabilitation center employees.
- Noted that despite our efforts to date around visitation banning, testing, screening, and infectious disease control, community spread is reaching nursing homes, assisted living and senior housing.
- Reiterated that staff that are symptomatic are not able to go to work.
- Made CLEAR that SNF operators MUST protect residents by following all CDC and MDH Infectious Disease Guidelines.
- SNFs must also protect staff by ensuring proper PPE and proper education of staff.
- Ordered that ALL SNFs and ALs staff must practice universal masking.
- Directed SNFs and ALs to use MD State Labs for urgent testing if a case is suspected (note that these are ordered by a local health office).
- Reiterated that SNFs are responsible for making safe discharges back to home; SNF residents who needed to be hospitalized but are recovering need to be able to go home and SNFs are their home.
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CMS Issues New Recommendations to Nursing Homes, State & Local Governments
The recommendations announced last night include:
- Nursing homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control, particularly focusing on consistent hand washing and changing and removing of PPE based on preliminary data from infection control focused surveys.
- CMS/CDC urges State and local leaders to consider the needs of long term care facilities with respect to supplies of PPE and COVID-19 tests.
- Medicare is now covering COVID-19 testing when furnished to eligible beneficiaries by certified laboratories. These laboratories may also choose to enter facilities to conduct COVID-19 testing.
- Nursing homes should immediately implement symptom screening for all staff, residents, and visitors – including temperature checks.
- An exception to this is Emergency Medical Service (EMS) workers responding to an urgent medical need. They do not have to be screened, as they are typically screened separately.
- Facilities should limit access points and ensure that all accessible entrances have a screening station.
- Patients and residents who enter facilities should be screened for COVID-19 through testing, if available.
- This new guidance can be provided to get the hospitalized patient tested before admission to the nursing home.
- Nursing homes should ensure all staff are using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE. The recommendations provide NEW detail on steps to take including:
- All long-term care facility personnel in the country should wear a facemask while they are in the facility.
- Full PPE should be worn per CDC guidelines for the care of any resident with known or suspected COVID-19 per CDC guidance on conservation of PPE.
- To avoid transmission within nursing homes, facilities should use separate staffing teams for residents to the best of their ability, and the administration urges nursing homes to work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status. The recommendations provide detail on steps to take.
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MDH Recorded Webinar
Yesterday, the Maryland Department of Health held a webinar call to update the LTC sector on COVID-19 developments and practices.
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MOLST and Advance Directives
Please be sure to review residents' advance directives and Maryland MOLST orders to ensure these documents are up-to-date.
Healthcare professionals can learn more about the Maryland MOLST form
HERE
.
In light of the high mortality rate (20-30%) for nursing home and assisted living community residents who become infected with COVID-19, we urge you to:
- Have conversations with residents and families about their end-of-life wishes now before someone becomes ill.
- Ensure residents’ advance directives, MOLST, and other documents are all up to date with current documented wishes, and physician orders are consistent with these wishes.
In the coming weeks, we expect to have hospital surges across the country that will exceed the capacity to transfer nursing homes and assisted living communities' residents with suspected or confirmed COVID-19. Discussing with residents and families now as to how they want to be cared for in place in the nursing home or assisted living community will be helpful to inform how to best meet their wishes, in advance of the anticipated continued spread of COVID-19, and its increased strain on the health care system.
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FAQs - Alignment of Isolation Waivers, MDS, and Payment Policies
AHCA has developed a
FAQ document
to help providers navigate how the various CDC and CMS COVID-19 guidance and Section 1135 waivers interact with current MDS-RAI coding guidance and payment models in SNFs, specific to situations where it is determined that a resident requires isolation related to the COVID-19 virus. This guidance is intended to provide context to help guide provider decisions and will be updated as necessary as new government policies and guidance are issued.
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WPS Posts Updated Accelerated Payment Request Form
On March 31, AHCA posted an Accelerated and Advanced Payments
FAQ document
that described the simplified process for providers to request accelerated payments to help with cash-flow during the next three months. The document included direct links to the MAC webpages where request forms could be completed, and submission instructions were detailed.
At the time, the Wisconsin Physician Services (WPS) J5 and J8 contractor sites did not have the COVID-19 related forms posted. Go to the updated WPS Medicare Part A
Jurisdiction 5
and
Jurisdiction 8
accelerated payment requests pages.
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Additional Updates from CMS
Here is a summary of recent Centers for Medicare & Medicaid Services (CMS) actions taken in response to the COVID-19 virus, as part of the ongoing White House Task Force efforts:
CMS Approves Additional State Medicaid Waivers and Amendments to Give States Flexibility to Address Coronavirus Pandemic
CMS approved its 44th state Medicaid waiver delivering urgent regulatory relief to ensure States can quickly and effectively care for their most vulnerable citizens. In light of the urgent and evolving needs of states during the COVID-19 crisis,
CMS
developed a toolkit
to facilitate expedited application and approval of State waivers requests in record time. The waivers support President Trump’s commitment to a COVID-19 response that is locally executed, state managed, and federally supported. Recently approved states include Alaska, Arkansas, and Nebraska.
CMS also approved one more state waiver amendment requests for California to give emergency flexibilities in their programs that care for the elderly and people with disabilities, bringing the total to 17 approvals across 15 states.
Medicare and Telehealth Services Blog
The Social Security Administration (SSA) featured a
guest blog
by CMS Administrator, Seema Verma with important information on Medicare coverage and recently expanded coverage of telehealth services. CMS actions protect beneficiaries while maintaining trusted access to care in the face of the coronavirus pandemic.
Medicaid Telehealth Flexibilities for Rural Health Care Substance Use Disorder
CMS released an
Informational Bulletin
to states that explains how states can use telehealth delivery methods to expand access to Medicaid services, including substance use disorder (SUD) treatment and services. The guidance outlines how telehealth may be used to service rural communities, high-risk individuals, school-based health centers and SUD programs. It provides information about Medicaid coverage and reimbursement of SUD treatment services and supports CMS actions in response to the COVID-19 virus as well as the opioid epidemic.
Updates Available to Medicaid and CHIP Frequently Asked Questions
CMS issued additional
Frequently Asked Questions for State Medicaid and Children’s Health Insurance Program (CHIP) agencies to aid states in their response to the COVID-19 outbreak. Topics include: emergency preparedness and response; flexibilities around eligibility and enrollment; benefits, premiums and cost sharing; financing; managed care; fair hearings; health information exchanges; and COVID-19 T-MSIS coding guidance.
To keep up with the important work the Task Force is doing in response to COVID-19, click here
www.coronavirus.gov
.
For information specific to CMS, please visit the
CMS News Room
and
Current Emergencies Website. CMS
updates these resources on an ongoing basis throughout the day; the information above is current as of April 3, 2020 at 10:00 AM.
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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.
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Additional Resources and Guidance
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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.
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