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COVID-19 Updates: March 27, 2020
This update includes:
- PPE Update
- COVID-19 State Legislative Request
- DQA: State Surveyors Will Bring Their Own PPE for any Survey Activity
- March 31, 2020, Assisted Living Forum – Assisted Living Regulatory Response to COVID-19
- President Signs COVID-19 Stimulus Bill into Law
- Bed Tax Update
- DHS COVID-19 Long-Term Care Meeting, 3.27.20
- CDC Call regarding Underlying Medical Conditions and People at Higher Risk for COVID-19
- Electronic Visit Verification Delayed
- Evolving Priorities for COVID-19 Testing in Health Care, Long-Term Care, and Other Settings
- David Mills, North Shore Healthcare CEO, Selected to Hospital Surge Capacity Strike Team
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BREAKING:
CMS today 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 and this is favorable news for our waiver request, which we hope is processed next week. WHCA/WiCAL has contacted Sen. Johnson and Baldwin's offices to expedite this request with CMS.
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.
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As of today, there are 842 confirmed cases of COVID-19 in the state of Wisconsin and five deaths caused by the virus. Click
HERE
to view the latest outbreak information from the Wisconsin Department of Health Services.
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WHCA/WiCAL Receives Briefing on PPE Supply
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WHCA/WiCAL received a briefing from the COVID-19 Response Strike Team dedicated to addressing the PPE shortage in Wisconsin.
One of the key messages that was offered to providers who have requested PPE through the stockpile is the need to make sure that the contact for the facility that is provided includes a phone number that is monitored 24/7. The shipping entity delivers the PPE requires the product to be delivered to an individual and they cannot do drop-offs.
The PPE Strike Team emphasized the need for facilities to continue to work with vendors to procure PPE, and use any supply chains available. State procurement officials continue to seek vendors to seek additional sources of PPE from different manufactures.
If facilities run out of PPE, members are urged to contact their
local Emergency Management Directors
. This is a change from previous direction, which requested that administrators contact local health departments. It is important for facilities to do this because it gets them in the emergency management pipeline, and connects them with the State Emergency Management Operations Center.
“We know that the people you represent are the key to make this work,” said Jeff Phillips of the State EOC of Wisconsin’s LTC providers. “We are doing everything that we can to put this in the hands of the people that will work.”
Moving forward, Phillips will be giving regular briefings to the state’s LTC provider associations regarding on-going PPE issues.
The issue of facility health department “lockdown” was also raised during the meeting.
WHCA/WiCAL continues to raise the concern about the need for local departments to emphasize conservation in this time of critical shortage of the availability of PPE. Phillips said that in meetings with the Health Departments this afternoon that he would emphasize these concerns, which he shared.
Phillips also discussed other strategies the Department is using including:
- A Buy-back program at the current going rate
- A Donation system where people or facilities that have PPE that can be donated
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COVID-19 State Legislative Request
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John Vander Meer, President & CEO of WHCA/WiCAL, had a meeting this morning with Speaker of the Assembly Robin Vos regarding the legislative package. Speaker Vos understood the nature of the crisis and indicated the the Legislature would be coming back in the next two weeks to take up legislation to address the COVID-19 pandemic.
WHCA/WiCAL encourages member facilities to contact their legislators.
Key Documents:
PPE: There is a critical shortage of available Personal Protective Equipment.
WORKFORCE: Wisconsin LTC facilities have been experiencing a workforce shortage. Wisconsin facilities have a 1 in 4 vacancy. No one really knows what a COVID-19 world with the Safer at Home Policy, unemployment benefits, lack of available PPE, lack of childcare, and the need for some people to take care of their own parents will mean for our staffing. Our associations want to communicate the fear that we hear in the dozens of calls our organizations take from providers every day.
We requested that a legislative relief package in response to the COVID-19 pandemic address the needs of long-term care facilities as providers work to protect and care for Wisconsin’s frail elderly population during this public health emergency
- $347 per patient day for Nursing Home Care
- $301 per patient day Increase of for Assisted Living Care
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DQA: State Surveyors Will Bring Their Own PPE for any Survey Activity
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WHCA/WiCAL confirmed yesterday that state surveyors will not enter Wisconsin nursing homes unless or until they have their own PPE. BNHRC Director Ann Angell said that surveyors will be equipped with their own PPE, and will keep contacts targeted to the purpose of the visit.
If state or federal surveyors are unable to meet the Personal Protective Equipment (PPE) expectations outlined by the latest CDC guidance to safely perform an onsite survey due to lack of appropriate PPE supplies, they are instructed to refrain from entering the provider, and obtain information necessary remotely, to the extent possible. Surveyors should continue the survey once they have the necessary PPE to do so safely.
If facilities have state surveyors show up and request entry, please contact
jstoa@whcawical.org. In the immediate moment, facilities should follow their current visitation protocol in adherence with CMS and DHS guidance.
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March 31, 2020, Assisted Living Forum – Assisted Living Regulatory Response to COVID-19
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Assisted Living providers and stakeholders are invited to attend this informative Assisted Living Forum. The following topics will be discussed:
- Temporary Modifications to CBRF Training
- Balancing Resident Rights and Safety During COVID-19
- Answering COVID-19 Questions for Assisted Living Facilities
The session will run from 10 a.m.-12 p.m. The sessions will be held using an online meeting technology:
To Join:
Meeting ID: 408 953 5984
Join by Phone: +1 312 626 6799
Please visit the
Assisted Living Forum webpage to obtain a copy of the agenda.
Submit any questions you would like addressed by completing this
survey
no later than Monday, March 30, 2020 at 4 p.m. If your question(s) pertains to a specific assisted living provider type (CBRF, AFH, RCAC, ADC), please be sure to include this information in your email.
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President Signs COVID-19 Stimulus Bill into Law
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Earlier today, President Donald Trump signed the Coronavirus Aid, Relief, and Economic Security Act (H.R. 748) into law, a
more than $2 trillion stimulus bill includes a number of measures affecting the long term and post-acute care (LT/PAC) profession, such as a temporary suspension of the Medicare sequestration cut and a $100 billion fund for eligible health care providers.
The bill also includes the deferral of the 6.2 percent payroll tax; $200 million in funding to prevent, prepare for, and respond to COVID-19; childcare support for health care sector employees; a new loan program for certain employers; and funding for housing for the elderly and those with disabilities.
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Long-term care providers are facing a multitude of challenges right now, amidst the COVID-19 outbreak. Many of these challenges are financial in nature. Paying the monthly provider tax is statutory but we realize this is an additional cost that providers are struggling with at a time when they are also facing a number of other additional costs. WHCA/WiCAL has communicated with the Medicaid Director, Jim Jones, who has indicated that providers having problems paying their provider tax should directly contact
Rene Eastman
, Section Chief for Nursing Home Rate Setting & Policy, and copying
Ben Nerad
, Director of the Bureau of Rate Setting about any issues they are having.
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DHS COVID-19 Long-Term Care Meeting, 3.27.20
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Earlier today, the Department of Health Services-Division of Quality Assurance held a webinar to answer questions from long-term care providers about the following subjects:
- Consumers/COVID-19
- Admission
- PPE
- Visiting
- Communication
- Testing
Read the highlights from the meeting
HERE!
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CDC Call Regarding Underlying Medical Conditions and People at Higher Risk for COVID-19
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During this call, the experts shared information on issues arising during this “acceleration” period of COVID-19. Most at risk people continue to be identified as over 50, including those over 65 who can suffer severe risk and death with certain conditions.
These include:
- Chronic Lung Disease or Asthma
- Serious Cardiac Issues including Heart Failure, Coronary Artery Disease, Hypertrophic Cardiomyopathy
- Immunocompromised
- Severely obese with BMI < 40
- Non controlled Diabetes
- Renal Failure
- Liver Disease
The physician speakers did not recommend any regimen changes for these patients if they are presently controlled.
At this time, there still continues not be to any medications or vaccines approved. Although clinical trials on some meds are in progress, there is nothing definitive at this time. You can see information on these clinical trials at
here.
LTC residents in Nursing Home, retirement centers and other congregate living environment remain at the highest risk mostly because of age and comorbidities listed above. They did identify high risk for dialysis residents and the justice facilities also as higher risk areas.
WHCA/WiCAL staff will continue to monitor and update you on any updates regarding the COVID-19 crisis. Direct any questions to Pat Boyer at
pat@whcawical.org
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Electronic Visit Verification Delayed
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In response to the COVID-19 pandemic, the Wisconsin Department of Health Services is delaying the start of training and the soft launch date (formerly September 1, 2020) requirement to use Electronic Visit Verification (EVV) for personal care services.
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Evolving Priorities for COVID-19 Testing in Health Care, Long-Term Care, and Other Settings
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- The Wisconsin State Laboratory of Hygiene (WSLH) and the Milwaukee Health Department Laboratory (MHDL) will continue to prioritize COVID-19 testing for patients with respiratory illness requiring hospitalization, and individuals with acute respiratory symptoms who are health care workers or provide other essential services such as first responders, law enforcement, and other public safety roles.
- Post-mortem testing can be performed at Wisconsin’s two public health laboratories, and will be prioritized (Tier 1) when it is necessary to inform public health investigations or infection control interventions.
- DHS and CDC continue to recommend against COVID-19 testing for asymptomatic individuals.
Ryan Westergaard, MD, PhD, MPH, Chief Medical Officer and State Epidemiologist for Communicable Diseases, shared the below message:
Dear Colleagues,
During the week of 3/23/2020, the overall laboratory capacity for COVID-19 testing in Wisconsin has increased. DHS has now received electronic laboratory results from at least 40 different clinical and reference laboratories, and the number of hospital-based laboratories conducting COVID-19 testing continues to grow. The volume of test results received by DHS is approaching 2,000 per day, and the proportion of tests that are positive this week has been between 3% and 4%.
Today, the CDC released updated guidance about which individuals should be prioritized for COVID-19 testing, which are now
summarized on the CDC website. The CDC guidance acknowledges that clinicians should use their judgment about whom to test, and also recognizes that local testing practices must vary based on resource limitations.
At this time, the Wisconsin State Laboratory of Hygiene (WSLH) and the Milwaukee Health Department Laboratory (MHDL) must continue to restrict COVID-19 testing to specific situations, to ensure that priority specimens are processed with the quickest turn-around time. We have, however, modified the criteria for which individuals will be considered highest priority (Tier 1 and 2), to support clinical and public health decisions in a timely manner. The modified table is below, and should replace the criteria described in memo
BCD 2020-09 dated 3/17/2020.
Specimens submitted to WSLH and MHDL should be accompanied by the
Patient Information Form as well as the appropriate laboratory requisition form. The
Patient Information Form has been modified to reflect the updated priority criteria outlined below.
The priority criteria developed by Wisconsin DHS for the public health laboratories are somewhat different than the criteria used in the new CDC guidance, but both agree in prioritization of testing for hospitalized patients and health care facility workers. Wisconsin providers can obtain COVID-19 testing for any patient using their clinical judgment, but at this time, tests not meeting the criteria listed in Tier 1 and Tier 2 should be performed at laboratories other than WSLH and MHDL.
TIER ONE:
Patients who are critically ill and receiving ICU level care with unexplained viral pneumonia or respiratory failure
-OR-
Patients who are residents of long-term care facilities or other high consequence congregate settings (e.g. prisons or jails), with unexplained fever OR signs/symptoms of acute respiratory illness.
-OR-
Post-mortem testing for people who died of unknown causes, if COVID-19 testing would influence infection control interventions or inform a public health response
TIER TWO:
Hospitalized (non-ICU) patients with unexplained fever AND signs/symptoms of acute respiratory illness
-OR-
Health care workers and first responders with unexplained fever AND signs/symptoms of acute respiratory illness, regardless of hospitalization
-OR-
Essential staff in high consequence congregate settings (e.g. correctional officers) with unexplained fever AND signs/symptoms of acute respiratory illness, regardless of hospitalization
TIER THREE: TESTING OF TIER THREE SPECIMENS WILL NOT BE PERFORMED AT WSLH OR MHDL
Patient is in an outpatient setting and meets criteria for influenza testing. This includes individuals with co-morbid conditions including diabetes, COPD, congestive heart failure, age >50, immunocompromised hosts among others
-OR-
Health care workers with acute respiratory symptoms (e.g. rhinorrhea, congestion, sore throat, cough) without fever
TIER FOUR: TESTING OF TIER FOUR SPECIMENS WILL NOT BE PERFORMED AT WSLH OR MHDL
Other patients, as directed by public health or infection control authorities (e.g. community surveillance or public health investigations)
DO NOT TEST
Patients without symptoms
Patients with mild respiratory symptoms only who are not health care workers
Wisconsin DHS and CDC continue to recommend not testing asymptomatic individuals for COVID-19 who may have been exposed to the disease. Individuals with possible exposure should be recommended to self-quarantine and monitor their symptoms. COVID-19 testing should only be used for making a diagnosis in patients with a clinical syndrome suggestive of the disease.
Thank you for your collaboration and support during these challenging times.
Sincerely,
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services
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David Mills, North Shore Healthcare CEO, Selected to Hospital Surge Capacity Strike Team
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David Mills, CEO of North Shore Healthcare, was selected to be a member of the Department of Health Services' Hospital Surge Capacity Strike Team.
WHCA/WiCAL has communicated to State Emergency Operations Center that the association wants to doing everything that we can to address the critical challenges facing the entire provider continuum as a result of the COVID-19 crisis. The Strike Team on Hospital Surge Capacity that has been developed needs to ensure that the systemic response to this crisis can evolve to compensate for the surge of patients and hopefully be able to avoid hospitals become overrun with patients due to COVID-19. We hope to help you access the resources that the state’s response needs to allow the state’s 11,000 hospital beds; 2,600 intensive care unit beds; and about 620 ventilators be able to be used most efficiently and effectively.
It is important to note that as this situation develops, the response will need to address the direct concerns of LTC facilities across the state. With that in mind, WHCA/WiCAL thanked state officials for ensuring the perspective of LTC providers is heard clearly in the process as the crisis response for all ends of the care continuum escalates.
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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.
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Pat Boyer, MSM, RN, NHA
| Director of Quality Advancement and Education |
pat@whcawical.org
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