COVID-19 UPDATE #172
July 28, 2021
CDC UPDATES GUIDANCE FOR FULLY VACCINATED INDIVIDUALS
Yesterday the Centers for Disease Prevention and Control (CDC) announced updated guidance for fully vaccinated individuals. This policy is aimed at preventing transmission levels of the highly communicable and now predominant Delta variant. The CDC has released additional information in its Mortality and Morbidity Weekly Report.

As of now, CDC guidance for long term care has not changed. However, this new guidance does impact staff outside of work, and we encourage you to educate your staff on this new guidance, the impact of the Delta variant, and the importance of getting vaccinated to prevent further spread.

As the Delta variant continues to spread, it will impact testing frequency and other infection control practices. Please double down on your efforts to follow CDC infection control guidance. AHCA/NCAL recommends reviewing the following CDC documents:
DOH "BACKSTOP" STOCKPILE - ORDER FREE PPE
On July 9, 2021, the Department of Health (DOH) issued a memo encouraging state agencies, counties, tribes and other partners to order PPE from the state backstop/ stockpile in order to achieve and maintain a 90-day supply to support COVID-19 related responses. DOH Prioritization Guidelines for Allocation of PPE are available here. The state is changing their processes for emergency PPE management effective October 31, 2021, and needs to disperse high levels of PPE to facilities now in order to move forward with future plans. Each facility is highly encouraged to put in a request for free PPE until that time, in order to maintain a 90 day supply.
 
Order forms for the state PPE must be completed and submitted to local county emergency managers. Please make sure to indicate clearly that you are a LTC facility. This applies to both skilled nursing and assisted living facilities. County emergency managers are able to answer questions about the forms and ordering process. For more information about ordering or to access the order form, click here. You may also email Jill Edgin, PPE Coordinator, DOH, or call her at (360) 584-5967.
AHCA/NCAL TO HOST WEBINAR ON HOW TO BOOST YOUR STAFF VACCINATION RATES
On August 11 at noon PST, AHCA/NCAL will host a webinar focused on the recent report, Invest in Trust: A Guide for Building COVID-19 Vaccine Trust Among Certified Nursing Assistants. The report’s lead researcher will share key findings from the report that was commissioned by the AHRQ ECHO National Nursing Home COVID-19 Action Network. You will also hear from two long term care providers who have worked hard to improve vaccination rates among their staff. Click here to register.
HHS RENEWED THE PUBLIC HEALTH EMERGENCY (PHE) EXTENDING ALL SECTION 1135 WAIVERS | SNF
On July 20, 2021, the HHS renewed the Public Health Emergency (PHE). The PHE renewal extends all Section 1135 waivers, irrespective of a state’s PHE status – the federal waivers remain in place. Based upon the PHE renewal are the following:
  • 3-Day Stay Waiver Remains in Effect: The waiver language is unchanged: “3-Day Prior Hospitalization. Using the authority under Section 1812(f) of the Act, CMS is waiving the requirement for a 3-day prior hospitalization for coverage of a SNF stay, which provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations, or are otherwise affected by COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (this waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the process of ending their current benefit period and renewing their SNF benefits that would have occurred under normal circumstances).” For more information, you may view the CMS Waiver Document here. 
  • SNF Providers Do Not Need Hospital Documentation: The 3-Day Stay Waiver is intended to free up as many hospital beds as possible by allowing beneficiaries who meet the Skilled Care Criteria to be directly admitted to a SNF. In regard to documentation, SNFs need only document that the beneficiary meets the SNF Criteria for Skilled Care and code claims associated with waiver stays using the disaster billing codes. View the billing instructions here. 
  • AHCA 3-Day Stay Guidance: AHCA developed 3-Day Stay guidance. Please note that this document indicates the waiver guidance is “until April 21, 2021.” This is an anachronism which we will be corrected. 
REMINDER: SKILLED NURSING FACILITIES MUST ALWAYS MEET CMS REQUIREMENTS AS A MINIMUM STANDARD
WHCA has heard feedback that some local health jurisdictions have directed skilled nursing facilities in response to an outbreak to follow guidance that is not as stringent as the CMS requirements/guidance. While the LHJ does have authority over outbreaks and subsequent testing, they do not have the authority to waive the Requirements of Participation--CMS requirements for a certified facility. The SNF must always meet the CMS requirements and guidance. Therefore, if the LHJ issues an order or recommendation that is stricter or more comprehensive than the CMS requirement, the facility must comply. However, the facility cannot meet the CMS requirements with a standard, testing or visitation guidance that is less restrictive or in violation of the CMS requirement. If you have questions regarding the CMS Requirements, please email Elena Madrid or call her at (800) 562-6170, extension 105.

In addition, please review CMS QSO memo 20-38 and 20-39 for details.
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.