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COVID-19 Update March 24, 2020

Posted By Jennifer Gill, Tuesday, March 24, 2020

 March 24, 2020

COVID-19 Update
March 24, 2020


Infection Control Worksheet
Cindy Deporter with NC DHSR sent out a Nursing Home Infection Control Worksheet that you may find helpful to review.

Dining Room Guidance from the State
Governor Cooper’s Executive Order No. 118 which included the shuttering of bars and restaurants now has a companion FAQ that provides specific guidance around dining rooms.

Conversations Revisiting End-of-Life Wishes and Advance Directives
In light of the high mortality rate (20-30%) for nursing home and assisted living community residents who become infected with COVID-19, a few things to keep in mind:

  • Have conversations with residents and families about their end-of-life wishes now before someone becomes ill. 
  • Ensure residents’ advance directives, Provider Orders for Life-Sustaining Treatment (POLST), 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 center 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.

1135 Waiver Request Approved
CMS has approved North Carolina’s 1135 waiver request. During times of emergency, states are allowed to waive certain Medicaid regulations. Among other things, this waiver allows North Carolina’s Medicaid program to:

  • Pay doctors who aren’t currently licensed in the state for providing care
  • Temporarily enroll providers who are licensed for Medicare or Medicaid in another state
  • Waive screening requirements upon enrollment of providers
  • Provide care at facilities which currently do not have a Medicaid license
  • Suspend patient pre-admission screening
  • Suspend other prior-authorization requirements

The waiver approved by CMS will grant North Carolina’s Medicaid program and the providers who are currently licensed or not currently licensed in the state with much more flexibility to treat patients and get paid for it. Similarly, Medicaid beneficiaries will have fewer requirements to meet to receive care.

North Carolina Board of Nursing Update
Julia George, CEO with the North Carolina Board of Nursing, has provided an update on alternate testing sites for nursing graduates, “graduate nurse” status, and efforts to reengage inactive and retired nurses. Click here for a look at her letter.

LeadingAge National Returns to Daily 3:30 Call-in
The LeadingAge national daily call-in is back and better than ever! 
Each day’s call will also provide up-to-the minute policy news and talk about implications for day-to day-operation of provider organizations across the continuum and highlight the latest Congressional actions that can provide relief and support for aging services providers.

Please note: whether you’ve participated in the calls before or not, you’ll need to register again. You’ll only have to register one time and you’ll will be registered for a 3:30 pm call every day (seven days a week) through April 26 .

CMS Survey Prioritization Memo
On March 23, CMS announced further suspension and re-prioritization of survey activity in response to the COVID-19 pandemic. 
Memo QSO-20-20-ALL highlights this re-prioritization, as well as new guidance for non-nursing home settings on visitors and screening, and access to all settings for health care providers.  The analysis on survey re-prioritization follows below.

Effective immediately for a period of 3 weeks only beginning March 20, the following types of surveys will be prioritized:

  • IJ complaint and facility-reported incident surveys: State survey agencies (SSAs) will conduct surveys related to complaints and facility-reported incidents (FRIs) that are triaged at the Immediate Jeopardy (IJ) level, including revisits necessary to confirm removal of IJ.
  • Targeted Infection Control Surveys: Federal and state surveyors will conduct targeted Infection Control surveys of providers identified through collaboration with the Centers for Disease Control and Prevention (CDC) and the HHS Assistant Secretary for Preparedness and Response (ASPR). 
  • Initial certification: Initial certification surveys will be authorized within current guidance and prioritization in order to help increase capacity.

The following surveys will not be conducted during this 3-week period of prioritization:

  • Standard surveys, including the Life Safety Code and Emergency Preparedness components of these surveys.
  • Complaint surveys triaged at a level below IJ. 
  • Revisit surveys that are not related to situations of IJ.

Surveys that are in process and do not meet the above criteria will be ended and surveyors will exit. When a survey is conducted due to a complaint or facility-reported incident triaged at IJ level, but the facility is ultimately not cited at IJ level, a revisit will not occur during the prioritization period. The case will be held and the facility has the option to hold submission of the plan of correction during the prioritization period. CMS will issue forthcoming guidance to address these scenarios. 

Hill Happenings
As we await action in the United States Senate on their latest coronavirus bill, the United States House of Representatives  is now working on its own bill.  Their bill includes a lot more money that would benefit many of our members.  Eldercare is on equal footing with childcare and employers with more than 500 employees would be included in the benefits.  But don’t take this to the bank yet.  We just received a new version of their “
Take Responsibility for Workers and Families Act .” Our analysts at LeadingAge national are good and are wading through the 1,404 pages to pull out the provisions most important to our members.

SNF 3-Day Stay Explainer
Here’s a shorter, clearer
explanation of the 3 day stay blanket waiver .

Medicaid HCBS Guidance
an article  explaining the new CMS guidance on HCBS what it means for those providers. It includes a section highlighting implications for adult day services.  While all providers are in a difficult position during the coronavirus crisis, adult day providers are at especially high risk because many have been forced to close.

Quality Reporting Relief
Click here
for a short article explaining the Quality Reporting guidance from CMS.  Click here for a revised SNF reporting deadline chart, taking the new guidance into account.  The important point is that while the guidance appears to offer some relief for providers, in reality you will need to continue submitting assessments as they are used for other purposes, such as determining payment.

Phishing Efforts by Scammers on the Rise
Click here for guidance from Skytel about an increase in phishing efforts by scammers eager to take advantage of the current crisis by victimizing your residents and your community.

LeadingAge NC COVID-19 Information Page
In addition to daily email updates, LeadingAge North Carolina is updating our COVID-19 information page daily with resources from trusted sources.  Click here  to view the page.  LeadingAge national has also set up a resources page.



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