LONG-TERM CARE TASK FORCE GOVERNOR’S COVID-19 Supports... · 8/6/2020 · Apr 1 Apr 15 Apr 30 Timeline of Notable Events: April 2020 Virginia COVID-19 LTC Task Force established

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office of the governor of the commonwealth of virginia

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GOVERNOR’S COVID-19 LONG-TERM CARE TASK FORCE

Dr. Laurie Forlano, Deputy Commissioner of Population Health, VDHGena Berger, Chief Deputy Commissioner, DSS

August 6, 2020

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Welcome and Housekeeping Items• Please mute your phone (do NOT put us on hold) if you are not

speaking• We prefer to take questions/comments at the end of each agenda

item • Feel free to utilize the chat box

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Overview of Agenda• Task Force Recap• Personal Protective Equipment Update• Testing Update

• Antigen Testing Recommendations• Financing Review• Visitation Guidelines Recap• Discussion• Next Steps

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COVID-19 Cases in LTCFs and Non-LTCFs Over Time

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COVID-19 Outbreaks in LTCFs and Non-LTCFs by Date VDH Notified

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Number and Region of LTCF COVID-19 Outbreaks by Data VDH Notified

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First COVID-19 case identified in

Virginia

7

12

Mar 1 Mar 31Mar 15

First COVID-19 death reported in

Virginia

14

First statewide webinar for ALFs

20

Timeline of Notable Events: March 2020

Governor declares State of

Emergency

17

First LTCF outbreaks

reported in Northern and

Central RegionsFirst statewide webinar for

nursing homes

28

First LTCF outbreak reported in Eastern Region

First LTCF outbreak reported

in Northwest Region

30

4

First statewide webinar about COVID-19 in healthcare facilities

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First LTCF outbreak reported

in Southwest Region

3

10

Apr 1 Apr 30Apr 15

Timeline of Notable Events: April 2020

Virginia COVID-19 LTC

Task Force established

CDC begins tele-ICAR project

with Virginia nursing homes

30

17

Governor signs Executive Order

Fifty-Seven

VDH Testing Team begins support for PPS

testing in LTCFs

First MRC deployment to support LTCFs

21

23

VANG conducts first PPS testing in

LTCF

12

Task Force Kickoff Meeting

16

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VDH releases COVID-19 Interim

Guidance for LTCFs

1

May 1 May 31May 15

CDC completes tele-ICAR project

with Virginia nursing homes

18

14

VDH releases Planning for PPS in

LTCFs

Timeline of Notable Events: May 2020

8

VDH releases COVID-19 LTCF Task

Force Playbook

CMS requires nursing homes to report data

in NHSN

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VDH releases Nursing Home

Reopening Guidance

18

Jun 1 Jun 31Jun 15

Timeline of Notable Events: June 2020VDSS releases ALF Reopening

Guidance

23

19

Governor announces $246

million support for LTCFs

24

HHS begins onsite IPCA visits in Virginia LTCFs

LTCF outbreaks posted on LTC

Task Force website

VANG begins calling all SNFs/ALFs with outbreaks

to offer baseline PPS

8

Reopening guidance

briefing with LTC

associations

Reopening guidance briefing with LHDs

Reopening guidance briefing with LTC

associations

26

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Jul 1 Jul 30Jul 15

24

HHS completes onsite IPCA visits in Virginia LTCFs

VANG ends support for PPS testing in LTCFs

2313


8

Reopening guidance briefing

with DARS

27

Reopening guidance

briefing with LTC

associations

17

VDH updates Nursing Home

Reopening Guidance

VDH updates

LTCF Playbook

10

1


Reopening guidance briefing with LTC

associations

Timeline of Notable Events: July 2020

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Long-Term Care Facility PPS’: Between 4/21 & 7/21

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PPS Results

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Phased Reopening: Nursing Home StatusNumber of New LTCF Outbreaks Reported to VDH in the Last 7 Days (August 5)

● Central Region: 1● Eastern Region: 2 ● Northern Region: 0● Northwest Region: 0● Southwest Region: 1

Statewide (August 5) ● Nursing homes in Phase I: 89● Nursing homes in Phase II: 36

Note these data are not being posted publicly; for internal situational awareness.Data are considered incomplete, as nursing homes are not required to report phase changes.

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Personal Protective Equipment (PPE) Update

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Testing UpdateAntigen Testing

Shaina Bernard, PharmD

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Viral Diagnostic TestsM

olec

ular

Ant

igen

Detects nucleic acid from the SARS-CoV-2 viral RNA

Detect the presence of SARS-CoV-2 antigen

Test performed at point of care (POC)

Test performed at moderate/high complexity lab

Many authorized by FDA

4 authorized by FDA

Abbott ID Now*Sensitivity: 94.7%Specificity: 98.6%

Test performed at point of care (POC)

Test performed at moderate/high complexity lab

2 authorized by FDA

2 authorized by FDA

Sofia 2 SARS Antigen* Sensitivity: 80%Specificity: 100%BD Antigen Test*Sensitivity: 85%Specificity: 100%

*Taken from assay’s IFU

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Point-of-Care Antigen Testing Key Points➔ Antigen tests are known to be less sensitive than molecular tests

◆ Amount of antigen in a sample may decrease as the duration of illness increases ◆ Negative results, from patients with symptom onset beyond five days, should be treated

as presumptive and confirmation with a molecular assay, if necessary, for patient management, may be performed

➔ Nursing homes performing POC tests must have an active CLIA Certificate of Waiver◆ More information can be found on the VDH Office of Licensure and Certification website

➔ Nursing homes that perform POC tests will be responsible for reporting results to public health◆ VDH is creating a portal specifically for these results to lessen the burden

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VDH NH Antigen Testing GuidancePhase Testing Scenario Testing Technology Recommended

I Initial baseline testing of all residents and staff with repeat testing of all residents and all staff, ideally within a week. Weekly testing can stop after 14 days of no new positive cases.

Initial baseline testing can be molecular or antigen. Repeat weekly^ testing should be molecular*.

I, II, III Testing symptomatic residents or staff. Molecular; Depending on known TAT of molecular tests, a rapid antigen test could be used. Negative antigen results should be confirmed by a molecular test, especially when symptom onset is greater than five days prior.

I Testing all staff and all residents in response to a positive staff member or NH-onset case (first round) with repeat testing of all residents and all staff, ideally within a week. Weekly testing can stop after 14 days (two rounds) of no new positive cases.

First round of testing can be molecular or antigen. Repeat weekly^ testing should be molecular*.

I, II, III Testing close contacts in response to a non-NH onset case. If additional cases are found, repeat testing of all staff and all residents, ideally within a week. Weekly testing can stop after 14 days (two rounds) of no new positive cases.

Molecular or antigen; negative antigen results should be confirmed by a molecular test. If additional cases are found, the first round of testing can be molecular or antigen. Repeat weekly^ testing should be molecular*.

II, III Testing close contacts in response to identification of a staff case with repeat testing of close contacts, ideally within a week. Weekly testing can stop after 14 days (two rounds) of no new positive cases.

First round of testing can be molecular or antigen. Repeat weekly testing should be molecular*.

^If an antigen test is performed for the first round of testing, the second round of testing by a molecular test can occur 3-7 days after. Waiting a week to confirm a negative antigen test result may not be warranted.*Repeat testing by molecular methods would confirm negative findings from the first round of antigen testing.

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Financing Update-Eligible CostsFunding can be used for COVID-19 related costs associated with:

● Testing● Employee wages, overtime pay, and bonuses, ● Employee benefits, ● Contracted services expense,● Employee child care costs, if applicable,● Employee isolation housing, if applicable,● Costs related to screening visitors,● Personal protective equipment and supply costs,● Cleaning and housekeeping supplies, ● Telehealth costs, ● Resident transfer costs, and● Other COVID-19-related expenditures.

Payments will be based on demonstrated / invoiced COVID-19 costs only.● Detailed invoicing instructions will be provided in August.

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Financing Update-Payment AmountsNursing Facilities will be eligible for a maximum payment calculated based on the following criteria:

● $27 per resident per day (less $20 Medicaid payment where appropriate)● $80 per resident per day during outbreaks● Additional support for periodic testing● Less payments received from Provider Relief Fund

Assisted Living Facilities will be eligible for a maximum payment calculated based on the following criteria:

● A facility-based payment of up to $4,000 for each assisted living facility each month (July, August, September, & October)

● An additional daily payment for four months to each assisted living facility based on the number of auxiliary grant (AG) recipients residing in the facility

○ This additional payment equivalent to $15.00 per AG resident per day

Initial communication from DMAS to providers will provide additional detail on maximum payment formula.

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Financing Update-Draft Schedule for CARES Act PaymentsJuly 1, 2020 Eligible costs begin date. Nursing facilities and assisted living facilities should make sure they are documenting their COVID-19 related costs for future invoicing.Week of July 27th DMAS awards administrative support contract. DMAS will contract with an external vendor to support communication with recipients, receipt of invoices, and review and audit of submissions.Early August DMAS or Admin Vendor will send communications to nursing facilities and assisted living outlining the process for submission and necessary documentation, with enrollment, invoice and cost reporting/reconciliation forms.Mid-August Invoices Start Being Accepted / Facilities Enroll for Payment. Facilities can submit invoices and necessary support documentation for costs incurred during July, 2020. Facilities will also have to document funds received from the Provider Relief Fund and DMAS's $20 per diem increase to calculate allowable expenses. Facilities will also have to submit required documentation for enrollment to be paid under this program. Please note, even if a nursing facility is already enrolled as a Medicaid provider, they will have to enroll separately to be paid under this CRF-funded program.

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Financing Update-Draft Schedule ContinuedLate August / Early September DMAS begins making payments. DMAS will process payments on a rolling basis every two weeks following the initial submissions as they are processed by the support vendor.

October 31, 2020 Eligible costs end date. Facilities should submit no costs incurred after October 31 for reimbursement. DMAS and vendor will not accept documentation for costs incurred after this date.

December 1 Final documentation due.

Late December / Early January DMAS makes final payments.

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Visitation Guidelines Recap● When in Nursing Home Reopening Phases I and II, VDH generally recommends against

face to face visitation except for compassionate care situations. ● Additional visitation practices, such as window visits and outside visits, are allowed if

facilities ensure social distancing and universal source control practices are adhered to.● When in Nursing Home Reopening Phase III, VDH recommends screening and additional

precautions including social distancing, hand hygiene (e.g., use alcohol-based hand rub upon entry), and the wearing of cloth face coverings or facemasks prior to allowing face to face visitation.

● Visitation policies are at the discretion of each facility based on phased reopening status and capacity for implementation of social distancing and universal source control practices.

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Discussion

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Next steps• Testing, Staffing, and Visitation Best Practices

Webinars

Documents

LONG-TERM CARE TASK FORCE GOVERNOR’S COVID-19 Supports... · 8/6/2020 · Apr 1 Apr 15 Apr 30 Timeline of Notable Events: April 2020 Virginia COVID-19 LTC Task Force established