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In observation of Memorial Day on Monday, May 25, the WHCA/WiCAL office will be closed.
We will reopen on Tuesday, May 26th.
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Virtual Spring Conference Live Session Schedule:
The Conference will remain open through June 26.
WiCAL MEMBERS
Please join Pat Boyer, Kate Dickson, and Dale Kelm on Wednesday, May 27 from 12:30-1:30 PM on the importance of PEAL/WCCEAL. This is a live webinar and all WICAL members are able to watch and participate in the webinar. If you are not already enrolled in the Virtual Conference, please secure your virtual seat
HERE
.
ALL ATTENDEES
please join our Cyber Security Panel - Pat LeMire (M3), Don Glidewell (Think Anew), Peter Kujawa (EO Johnson), and Paul Johnson (Wipfli) on Thursday, May 28, from 10-11 AM for a LIVE Q&A covering all aspects of Cyber Security, including up-to-date information for our long term care communities and the heighten need for cyber security awareness during this pandemic. We encourage you to pre-register for this LIVE session in the Virtual Conference.
Don’t worry, if you are unable to attend a live session, it will be recorded and added as an on-demand session, that you may view in accordance with your own schedule.
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COVID-19 Updates: May 22, 2020
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This update includes:
- DHS-DMS Provides Background on CARES Act Payment Methodology
- Direct Care Workforce Funding Initiative Updates
- HHS Releases $4.9 Billion to Skilled Nursing Centers
- North Shore Healthcare CEO: "This Is a Breaking Point"
- Clarification regarding COVID-19 Testing and Visitation Guidance for Assisted Living
- Upcoming Webinar Next Week! The Advantages of PEAL/WCCEAL
- Update on Froedert PPE Supplies
- Access to Remdesivir under Emergency Use Authorization for Wisconsin Hospitals
- Instructions for Requesting Access to COVID-19 Lab Results Lookup Report
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As of today, there are 14,396 confirmed cases of COVID-19 in the state of Wisconsin and 496 deaths caused by the virus. Click
HERE
to view the latest outbreak information from the Wisconsin Department of Health Services. Click
HERE
to view COVID-19 projections for Wisconsin and the United States.
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DHS-DMS Provides Background on CARES Act Payment Methodology
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WHCA/WiCAL received a briefing Friday morning on the methodology for the $100 million CARES Act funding being distributed by the Wisconsin Department of Health Services (DHS).
DHS-Division of Medicaid Services (DMS) officials indicated they received a request on Monday from the Governor’s Office to design a methodology to push payments out to long-term care providers. Particular emphasis was placed on getting the money out to providers as quickly as possible in the first round. As a result of the fact that all facilities have experienced increased costs and decreased revenues related to COVID-19, the first round is designed to be general to all providers, and the second round of payments is expected to be more defined and targeted to specific providers affected, presumably by active cases of COVID-19, but no criteria or timetable has been shared at this point.
There are four provider groups that are receiving funds as a result of the CARES Act allocation:
- ALFs
- SNFs
- HCBS providers
- EMS
It is important to note that all licensed providers of the above types are eligible to receive funding – they do not have to be participating in the Medicaid or Family Care programs to be eligible.
The methodology is based on the percentage of the total Medicaid spend each of the above groups represents, divided by the number of providers in each category. The resulting amounts to each category are:
- $23.9M – SNF
- $30M – ALF
- $44.9M – HCBS
- $1M – EMS
While issues are still being ironed out, DHS-DMS are looking to have the application period open beginning on June 5. As a result of the fact that May financials will have to be reconciled, WHCA/WiCAL representatives have requested that the application process remain open until the end of June. There are hopes that the Department could process applications on a rolling basis so that some payments could be made as soon as applications come in and are process.
DHS-DMS officials indicated that they expect the DHS web-based application to be available on June 5, with approximately $50 million being allocated, and then a subsequent allocation going out at a later time that is currently to be determined. Providers will need to complete the application in order to receive the funding. Every effort is being made to ensure that the web-based application is as simple as possible. The information requested in the application will include: provider name, NPI, 2019 revenue, CARES Act revenue, revenue losses and additional costs related to COVID. These costs could include additional staffing costs such as overtime, hazard pay, retainer payments, as well as lost business because facilities were unable to take admissions. Any CARES Act funds that a provider has already received will be deducted. DHS indicated they would use the same criteria for loss calculations as used for the CARES Act federal relief fund. Remaining losses will determine how much a provider will receive. DHS personnel indicated that there will not be an extensive auditing process after the allocation, but this is designed to ensure providers are making a good faith effort for the necessary allocation. It is important to note that the Department is not able to use MMIS as a vehicle for these payments as a result of the fact that they cannot be specifically associated with the Medicaid program, but rather must be general payments. Associations have requested that these payments be made on a cash and not accrual basis, and that these payments be provided on an automatic deposit basis.
Funding will be allocated based on the number of beds per facility. All providers are eligible regardless of provider mix. The preliminary amounts below show maximum allocations for the first payment:
All ALFs: AFHs, CBRFs, RCACs
- 3-4 – $1,000
- 5-15 – $2,280
- 16-25 – $5,150
- 26-40 – $8,450
- 41-60 – $12,870
- 61-100 – $19,790
- Greater than 100 – $34,380
SNF Funding Allocation:
- $41,000 – greater than 100
- $29,000 – 50-100
- $14,270 – under 50 beds
An FAQ document on how the CARES Act Funding will be distributed by DHS as early as Tuesday. WHCA/WiCAL has requested the Department offer a webinar for providers detailing how to complete the application process and how the funding process will work.
WHCA/WiCAL is also working with the Department on ways to easily gather the required data from providers.
If providers have questions, please contact Director of Reimbursement Policy
Kate Dickson
.
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Direct Care Workforce Funding Initiative Updates
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The Department of Health Services (DHS) held a Direct Care Workforce Funding Initiative workgroup meeting this afternoon to update stakeholders on the status of the remaining 2019-2021 biennium payments.
WHCA/WiCAL announced on Tuesday that an additional $11.5 million was added to the program’s funds. This increase results from an increase in federal matching funds allocated as a result of the federal stimulus legislation. The total funds for the program went from $128 million to almost $140 million.
The first payment of the 2019-2021 biennium was made to providers in April after CMS approved DHS’s plan. CMS has currently approved a twice per year payment structure rather than the previous quarterly system. To finish out the 2019 fiscal year payments, DHS announced the next payment will start going out to providers on June 19. This payment will include the additional $11.5 mentioned above. The total payment amount will be $54.3 million – April’s payment was $21.4 million. The June payment will be based on encounter data from January and February 2020.
Next, DHS plans to make a payment to providers in December 2020 or January, 2021 of $43 million using March-August 2020 encounter data. The final payment of the biennium will likely be around June 2021.
Providers will no longer be expected to complete a quarterly attestation but a once per year survey instead. There was no timeline provided for this survey. DHS personnel indicated the purpose of the survey is to gauge the effectiveness of the program and see where money is being spend among the approved options. In addition to attestation and survey changes, providers will now have six months to distribute each payment to workers and may claim expenditures made in the prior 12 months as appropriate uses of the direct care workforce funding.
Specific to COVID-19, supplemental payments to workers above and beyond a worker’s normal reimbursement for hours worked are allowable uses of the direct care workforce (DCW) funds. Some allowable COVID-19 DCW expenses include, but are not limited to, additional paid time off, hazard pay, increased overtime, and increased weekend and night differentials.
Finally, the redistribution of settled 2019 funds will be going out to providers starting on May 29, 2020. This entire payment only totals $2.3 million so it will be a smaller payment than the others.
As a reminder, per the structure of the Family Care Direct Care Workforce Funding program this funding will be made available for providers to distribute to frontline caregivers in assisted living facilities and other Family Care HCBS settings. More information about the program can be found
here
. DHS indicated this page will be updated soon to reflect the dates discussed in this update.
Please reach out to Director of Reimbursement Policy
Kate Dickson
with any questions.
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HHS Releases $4.9 Billion to Skilled Nursing Centers
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AHCA/NCAL President & CEO Mark Parkinson shared the below message:
You have been on the front lines for months, working hard to prevent and contain this deadly virus, especially in a number of the hot zone areas. I know that these resources are essential during this difficult time.
Every provider, whether you have cases of COVID-19 or not, is fighting to protect residents or keep the virus out the building. This has required substantial outlays for PPE, testing, agency staff and hero pay for regular staff as we isolate and cohort residents, prevent staff from working across units, and increase cleaning and infection control procedures. If a nursing home has COVID-19 positive patients, those costs double and triple.
Providers will be paid electronically where possible. Providers who normally receive a paper check for reimbursement from CMS will receive a paper check in the mail for this payment as well, within the next few weeks.
HHS will make relief fund distributions to SNFs based on both a fixed basis and variable basis.
Each SNF will receive a fixed distribution of $50,000, plus a distribution of $2,500 per bed.
Providers must
attest that they will only use Provider Relief Fund payments for permissible purposes and agree to comply with future government audit and reporting requirements.
Unfortunately, assisted living providers still have not received the relief funds they need. This has happened for a variety of reasons. One issue is that because assisted living is not federally regulated, there is not a simple way to create a group of eligible providers or a methodology to pay them. We know this is creating a real hardship for our assisted living members and we are committed to working on this challenge.
I know that the resources announced today are critical for providers. Our state affiliates and members across the country have worked tirelessly on this effort, contacting every Member of Congress with requests to advocate to HHS on our behalf. These resources are welcome news, but we are not done yet. We realize that many of you have mounting challenges in the weeks and months to come. AHCA/NCAL remains focused and committed to working on your behalf. We’re so proud to be able to represent you, especially now. You are saving lives.
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North Shore Healthcare CEO: "This Is a Breaking Point"
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More Wisconsin nursing homes will likely close due to the COVID-19 crisis as the pandemic continues to exacerbate existing funding and workforce challenges, North Shore Healthcare CEO David Mills said Thursday in an event with Wisconsin Health News.
“I don’t think there’s any question about it,” Mills said during a Wisconsin Health News
live virtual event. “There were many providers just with razor thin margins hanging on prior to this. Unless some significant changes happen shortly with funding and so forth, I am not sure how they are going to survive. This is a breaking point for them.”
Since 2016, nearly 40 Wisconsin nursing homes have
closed.
Nursing home groups have raised the alarm for years about low Medicaid rates and persistent struggles to attract enough workers.
Mills said that in recent months occupancy rates are down more than 10 percent, costs to acquire needed personal protective equipment are up 300 percent and “staffing challenges have not gotten better.”
Meanwhile, the congregate nature of nursing homes and their average patient profile – elderly with comorbidities – have placed them at the center of the COVID-19 crisis.
“That creates somewhat of a perfect storm for a skilled nursing environment or congregate living,” Mills said.
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Clarification regarding COVID-19 Testing and Visitation Guidance for Assisted Living
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The following information was sent to the Division of Quality Assurance (DQA) listserv earlier today.
Testing
DHS continues to prioritize COVID-19 testing in congregate living settings for asymptomatic residents and staff. Currently, DHS is working with nursing homes to complete this testing by the end of May. While this is occurring, DHS is developing guidance and strategies to further support COVID-19 testing in other congregate settings such as assisted living facilities for asymptomatic residents and staff. Guidance will be issued for assisted living providers in the near future. Thank you for your patience.
Visitation Guidance
People who live in our nursing homes, assisted living communities, and the staff and caregivers are at a high risk of contracting COVID-19. Their safety and wellbeing continues to be a top priority for DHS. When a resident or staff member tests positive for COVID-19, the potential for rapid spread can be extremely high and life-threatening and asymptomatic individuals who are COVID-positive can spread the virus. In order to minimize spread, we ask that long-term care settings remain vigilant about minimizing the number of people entering their buildings from the community. The Department of Health Services continues to support the following guidance regarding visitation of residents by family members. This information is consistent with the Centers for Disease Control guidance for assisted living facilities,
Considerations When Preparing for COVID-19 in Assisted Living Facilities and information published on the
DHS COVID-19 webpage.
Restrictions on visitors:
- Facilities should restrict all visitors and nonessential health care personnel, except for certain compassionate care situations, such as an end-of-life scenario. Facilities should notify potential visitors of the need to defer visitation until further notice (through signage, calls, letters, etc.).
- In compassionate care situations, visitors will be limited to a specific room only. Facilities should require visitors to perform hand hygiene and use personal protective equipment (PPE), such as face masks. Decisions about visitation during an end-of-life situation should be made on a case-by-case basis, which should include careful screening of the visitor (including clergy, bereavement counselors, etc.) for fever or respiratory symptoms.
- Individuals with symptoms of a respiratory infection (fever, cough, shortness of breath, or sore throat) should not be permitted to enter the facility at any time (even in end-of-life situations).
- Visitors that are permitted to enter must wear a face mask while in the building and restrict their visit to the resident’s room or other location designated by the facility. Facilities should also remind visitors to frequently perform hand hygiene, especially after coughing or sneezing.
Health care workers:
- Offering alternative means of communication for people who would otherwise visit, such as virtual communications (phone, video-communication, etc.).
- Creating and/or increasing listserv communication to update families, such as advising them to not visit.
- Assigning staff to serve as the primary contact to families for inbound calls, and conducting regular outbound calls to keep families up to date.
- Offering a phone line with a voice recording updated at set times (for example, daily) with the facility’s general operating status, such as when it is safe to resume visits.
- Use Facetime, Skype or other mobile media, if your resident has access to a device, or as arranged by the home.
- Send extra cards, notes, postcards, being sure to keep your message short and positive.
- Phone your resident often, but please try not to call during the busiest times of day if staff need to assist your resident with the phone.
- If your resident is unable to talk on the phone or use mobile media to stay in touch, ask the staff if someone can call you periodically to give you an update about how your resident is doing.
These recommendations are to keep our residents of Wisconsin assisted living communities protected from the COVID-19 virus, but also the staff and caregivers who work in those settings. In these days, where many long-term care settings are already working with fewer staff than they would like, they cannot afford to lose even one to this virus for any length of time. If your facility has developed additional creative ways for residents to connect with their loved ones, please share those with us on the weekly Assisted Living Provider Forums. Thank you for your help in protecting Wisconsin’s most vulnerable citizens.
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Upcoming Webinar Next Week! The Advantages of PEAL/WCCEAL
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The WHCA/WiCAL Virtual Spring Conference will be holding a webinar on Wednesday, May 27 on the Advantages of PEAL/WCCEAL. We will be allowing WiCAL members who have not signed up for the virtual conference to attend this session. Pat Boyer, WHCA/WiCAL Director of Education and Quality Advancement, will be doing a Q&A session at the conclusion of the webinar.
WHEN: May 27, 2020
TIME: 12:30-1:30 p.m. CST
COST: Free
Webinar registration closes Monday, May 25. If you are not already an attendee of the WHCA/WiCAL Virtual Spring Conference, click
HERE to register.
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Update on Froedert PPE Supplies
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Earlier this week, Pat Boyer asked Clinical Leaders about their need for PPE. Froedtert Hospital had indicated that they had supplies that they could distributed. Pat communicated the request for gowns that many of you expressed a need for. Unfortunately, we received a message from Froedtert yesterday that they do not have gowns either and could not assist us so please continue with your normal means of supply ordering.
In addition, Froedtert staff have offered to distribute 25 Elastomeric masks to facilities with ventilator residents. WHCA/WiCAL has communicated to them, given them the names and contact people and requested that they proceed with that distribution. These do require specific decontamination so please read the information supplied carefully.
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Access to Remdesivir under Emergency Use Authorization
for Wisconsin Hospitals
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This message was sent to the COVID-19 Health Alert Network (HAN). The HAN will be the primary method for sharing time-sensitive public health information with clinical partners during the COVID-19 response. Health care providers and other officials can subscribe and unsubscribe using their preferred email address at the
DHS COVID-19 website
.
Summary
- Remdesivir, an investigational drug being studied for treatment of severe COVID-19, is available for use in the United States after receiving Emergency Use Authorization (EUA) by the FDA.
- A limited supply of remdesivir has been distributed from the federal government to the Wisconsin Department of Health Services, for distribution to Wisconsin hospitals. DHS is making the drug available for hospitalized patients who meet clinical criteria specified under the EUA.
- Hospitals can request one or more cases, each containing 40 single-dose vials of remsdesivir, from the State Emergency Operations Center, for next-day delivery. If more requests are received than can be filled, the state will give priority to hospitals currently caring for the highest number of COVID-19 patients.
Remdesivir is an investigational antiviral drug that is being studied for treatment of COVID-19. Findings from several clinical trials have provided preliminary evidence that patients receiving remdesivir may have a shorter duration of illness, in comparison to patients who received placebo. Studies have not found evidence that remdesivir lowers the risk of death of patients with COVID-19, or prevents progression to severe disease among patients with mild illness. At this time, remdesivir is not an FDA approved treatment for any condition, and there is not sufficient evidence of benefit that the government can recommend for or against its use.
Based on the early findings suggesting a potential benefit, on May 1, 2020, the FDA issued an Emergency Use Authorization (EUA) to allow remdesivir to be distributed and be used by licensed health care providers to treat adults and children hospitalized with severe COVID-19. Severe COVID-19 is defined as patients with an oxygen saturation (SpO2) ≤ 94% on room air or requiring supplemental oxygen or requiring mechanical ventilation or requiring extracorporeal membrane oxygenation (ECMO).
After the FDA’s EUA, the manufacturer of remdesivir, Gilead Sciences, made a donation of the drug to the federal government for distribution to patients hospitalized with severe COVID-19. On May 16, 2020, the US Department of Health and Human Services sent a communication to states which read:
"We expect to receive a minimum of 940,000 vials, per the donation agreement with Gilead. This current shipment represents 206,640 vials, or 22%, of the overall expected total. When the initial shipment arrived at HHS from Gilead on May 4, 2020, a partial shipment of the medication was sent directly to hospitals in seven states, which was approximately 3.6% of the total expected donation. When it became clear that each State would need to develop clear, individualized criteria for their communities based on the efficacy data in the initial clinical trial, shipments were shifted to the States for distribution to hospitals as needed, beginning with the previously shipped emergency supply, and followed by this current distribution. We expect to deliver a shipment of 5,275 cases, or 211,000 vials, of remdesivir this week, which will be distributed using the same hospital case-based algorithm."
Wisconsin received two shipments of remdesivir from the federal government, on May 12 and May 15. Because the number of doses received by the state was small in comparison to the number of patients hospitalized with COVID-19, DHS invited hospitals to request remdesivir in batches sufficient for 5- or 10-day treatment courses for individual patients. In the first allocation, hospitals requested treatment courses for 90 patients, and DHS distributed its entire allocation the following day, which included treatment courses for 52 patients.
A smaller number of requests were received from hospitals after Wisconsin received its second allocation on May 15. As a result, all hospitals requesting remdesivir from this allocation received the requested number of doses on May 16. For future allocations of remdesivir, including a new shipment of 26 cases on expected on May 20, 2020, DHS will allocate entire, unopened cases of remdesivir to hospitals, each containing 40 single dose vials. This strategy is consistent with the approach taken by other states in our region, and is advantageous because hospitals may store unused drug at their pharmacy for use in future patients, avoiding potential treatment delays associated with requesting doses from DHS. Hospitals with small numbers of patients with COVID-19 also have the option of requesting individual treatment courses.
To request one or more cases of remdesivir, hospitals must submit a
Remdesivir Case Request Form to DHS [DHSOperations@dhs.wisconsin.gov] before 4:00 pm on 5/22/2020, containing (1) the number of cases or treatment courses requested, and (2) the total number of patients currently hospitalized in their facility who meet the eligibility criteria for remdesivir. These criteria include:
- Laboratory-confirmed COVID-19
and
- Oxygen saturation (SpO2) ≤ 94% on room air or requiring supplemental oxygen OR requiring invasive mechanical ventilation or requiring ECMO
Hospitals are required to provide an accurate account of the number of COVID-19 patients in their current inpatient census, and to agree to only administer remdesivir to patients in accordance with the specifications described in the Emergency Use Authorization. Failure to meet these obligations may result in loss of access to future allocations of medications through DHS. If the number of cases of remdesivir available through DHS is not sufficient to fill all requests received from hospitals, DHS will allocate the available cases by giving priority to hospitals with the greatest number of eligible COVID-19 patients.
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Instructions for Requesting Access to COVID-19 Lab Results Lookup Report
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Providers may access patient COVID-19 lab results. Patient lab results are located in the Public Health Analysis Visualization and Reporting (PHAVR) web portal. In order to access patient lab results through PHAVR, the provider must register and receive log-in information through the Wisconsin Logon Management System (WILMS).
The instructions
HERE will help providers navigate how to request and gain access to patient lab reports.
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Pat Boyer, MSM, RN, NHA
| Director of Quality Advancement and Education |
pat@whcawical.org
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Business Partner Spotlight
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The food service team at Martin Bros. is the most experienced in the region, staffed with professionals and specialists who deliver the very best in food products, restaurant supplies, chef supplies and more. We take the time to truly understand your organization’s unique needs, and continuously focus on helping you reach your goals and meet the demands of your business, your staff, and customers.
For more than 75 years, it’s been the talent and hard work of our experienced team who has allowed us to become such a trusted leader in the food service wholesale field. We deliver unparalleled personal attention, whether you’re managing a restaurant, school, university, healthcare facility, convenience store, hotel, or casino.
CONTACT:
Martin Bros. Distributing
For the complete listing of WHCA/WiCAL Gold Business Partners, click
HERE
!
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