COVID-19 UPDATE #89
October 12, 2020
REIMPLEMENTATION OF INSPECTION AND INVESTIGATION ACTIVITY
In a Dear Administrator letter dated October 9, 2020, all providers were notified that the Centers for Medicare and Medicaid Services (CMS) has announced the reimplementation of inspection and investigation activities effective November 1, 2020. Reimplementation activities include investigations, re-certification surveys, and other field work, including the work of the Case Mix, Residential Inspection and Quality Assurance, Behavioral Health Quality Improvement Consultation, and Training Programs. The letter also outlines guidance given to Residential Care Services (RCS) staff regarding the use of personal protective equipment (PPE) and conducting investigation and inspection assignments.
ON-THE-JOB TRAINING FOR HOME CARE AIDES
In a Dear Administrator letter dated October 8, 2020, assisted living providers are notified of an on-the-job training opportunity created by DSHS in collaboration with WHCA and other advocacy groups. The letter provides requirements in WAC 388-112A-0330 and shares that there is now a standardized method to implement the program. The letter also shares a series of webinars that will be hosted in November to provide instruction and information for facility providers on how to successfully implement an on-the-job training program.

Click any link below if you wish to register for one of the webinars being offered.

If you have questions or would like additional information about an on-the-job training program, please email Julie Peters or call her at (360) 725-2515.
GUIDANCE RELATED TO EMERGENCY PREPAREDNESS TESTING REQUIREMENTS IN SKILLED NURSING
A Dear Administrator Letter dated October 8, 2020, informs skilled nursing providers of CMS QSO-20-41 regarding emergency preparedness testing exemption and guidance in times of Public Health Emergency. CMS regulations require specific testing exercises be conducted to validate the facility’s emergency program. During or after an actual emergency, the regulations allow for an exemption to the testing requirements for providers that experience a natural or man-made event requiring activation of their emergency plan.

Facilities that activate their emergency plans are exempt from the next required full-scale community-based or individual facility-based functional exercise. Facilities must be able to demonstrate through written documentation that they activated their program due to the emergency. Facilities may need to conduct an exercise of choice following the current Public Health Emergency if they were required to conduct such an exercise this year and did not already do so. If providers have questions about this matter, please email Lisa Herke, Nursing Home Policy Program Manager, or call her at (509) 209-3088.
SKILLED NURSING RESIDENTS' RIGHT TO VOTE
In a Dear Administrator letter dated October 8, 2020, skilled nursing providers are given information regarding residents’ right to vote and reminded that facilities must support or promote those rights. The letter refers to QSO-21-02 issued by CMS on October 5, 2020. The letter instructs providers to follow the Safe Start for Long Term Care guidelines if people outside the facility are used to assist with the polling process. The letter also provides information on how residents or their representatives can file a complaint if they feel their rights under the regulations have been violated. 
CMS RELEASES MEDICARE ACCELERATED AND ADVANCE PAYMENT GUIDANCE
The Centers for Medicare and Medicaid Services (CMS) has released updated Medicare Accelerated and Advance Payment guidance based upon the recently enacted Continuing Appropriations Act, 2021 and Other Extensions Act. 

The CMS guidance outlines the following repayment schedule: 
  • Repayment does not begin for one year starting from the date the accelerated or advance payment was issued (e.g., the date a facility received its payment); 
  • Beginning at one year from the date the payment was issued and continuing for 11 months, Medicare payments owed to providers and suppliers will be recouped at a rate of 25%; 
  • After the 11 months end, Medicare payments owed to providers and suppliers will be recouped at a rate of 50% for another six months; and 
  • After the six months end, a letter for any remaining balance of the accelerated or advance payment(s) will be issued. 

If such a letter is issued, skilled nursing facilities will have 30 days from the date of the letter to repay the balance in full. If payment is not received within 30 days, interest will accrue at the rate of 4% from the date the letter was issued and will be assessed for each full 30-day period that the balance remains unpaid. Information related to Extended Repayment Schedules will be included in these letters. CMS may immediately issue these letters to skilled nursing facilities that received accelerated or advance payments in error. 

In a departure from previous policy, CMS notes that skilled nursing facilities can submit one or more lump sum payments to pay off all or some of their total balance. To arrange a lump sum payment, CMS indicates skilled nursing facilities should contact their MAC(s) for more instructions on how to make a lump sum payment, especially if payment will be made after the repayment timeframe begins.  

For questions related to the Accelerated and Advance Payment Program, CMS has established COVID-19 hotlines at each MAC that are operational Monday through Friday to assist all providers with accelerated or advance payment concerns. Providers can contact the MAC that services their geographic area(s). To locate designated MAC areas, visit the MAC website list. For additional information, the CMS fact sheet is located here, and the FAQ document is located here.
COVID-10 PROCLAMATIONS EXTENDED THROUGH NOVEMBER 9
In a Dear Administrator letter dated October 7, 2020, all providers are notified that the Washington State Legislature has extended the end date of 26 Governor Proclamations through November 9, 2020. The proclamations include several related to assisted living and skilled nursing centers. The letter provides a list of proclamations related to long term care.
CMS COVID-19 STAKEHOLDER ENGAGEMENT CALLS
The Centers for Medicare and Medicaid Services (CMS) hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts. Conference lines are limited, so individuals are encouraged to join via audio webcast on a computer or smartphone browser. All CMS call recordings and transcripts are posted here. The most current information, including call schedule changes, is provided here.

Upcoming calls are:
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.