Embed Size (px)
Citation preview
Safe and CalmDECEMBER 23, 2020
Agenda1. Safe and Calm Holiday Schedule
2. Advocacy - Lame Duck Wrap Up
3. Vaccination and Mandating◦ Elisa Lintemuth
Member, Dykema
4. CRC Overview and Lessons Learned◦ Dana M. Prince, PhD
Executive Director, St. Ann’s
Holiday Webinar Schedule
December 25: Holiday
December 30: Tentative: we will hold the Safe and Calm Webinar if there is new relevant information and members are available considering the vaccine plan.
January 1: Holiday
2020 Legislature Wraps Up The legislature wrapped up for the year after a special session on Monday
◦ Passed several bills
◦ Including a supplemental budget bill
A national COVID-19 relief package sent to the president’s desk
The package does not have state budget relief in it◦ Negotiated in a separate package
The bills I am about to talk about are not yet law. All of them are on the governor's desk waiting for her signature.
◦ Her team needs time to analysis the bills
◦ The governor will not be vetoing any bill before the 25
Budget Supplemental (SB 748) Presented to the governor yesterday afternoon
◦ She has spoken positively about the bill
$465 Million total
◦ $262 million being used to cover the temporary extension of unemployment benefits from 20 weeks to 26 weeks for Jan. 1, 2021 – April 1, 2021
$103.85 million for vaccination, testing and COVID-19 response efforts
$100.0 million to extend the $2.00 per hour direct care worker wage increase for an additional 2 months.
$2.0 million to extend the $200 per day enhanced payment for CRCs for an additional 2 months
Previously Mentioned BillsSenate Bill 77 – Electronic Monitoring Bill
◦ Conversations with their team indicate that the governor is not a fan of the bill
◦ The governor's team did not say weather she will or won’t sign the bill
House Bill 4098 – Medication Aide Bill ◦ Governor has yet to comment on the legislation
◦ Passed along party lines
Senate Bill 1185 – Health Care Facility Legal immunity ◦ Governor has yet to comment on the legislation
◦ Took a lot to pass the last immunity bill
◦ Passed along party lines
Other bills on the governor's desk House Bill 4910/4911 – Misrepresentation of Emotional Support Animals Act
◦ Creates more flexibilities for housing providers who are seeking more information regarding a support animal
◦ Passed with bipartisan support
Senate Bill 1021 – Creates license reciprocity for individuals educated in Canadian ◦ Passed by the full chamber
House Bill 4042 – Would add Michigan to the national nurse licensure compact◦ A Michigan nursing license would be applicable in many other states and vice versa
◦ Passed with bipartisan support
House Bill 4491 – Would change the licensure requirements relating too “good moral character”◦ Only felony's can be revied upon licensure application with some expectations
◦ Passed with bipartisan support
Important Dates12/31/2020
Deadline for the purchase or initialization of equipment paid for by the Nursing Facility Infection Prevention Grants
1/31/2020 Estimated end date for the distribution of the 3rd round of PRF funds
2/1/2021Deadline for SNFs to submit expenditure documentation of the Nursing Facility Infection
Prevention grant funds to MDHHS
2/28/20End of the third reimbursement period for Direct Care Worker Wage Pass-through payments
2/28/2020 End of the $200 Enhanced CRC payments
Questions
?
California | Illinois | Michigan | Minnesota | Texas | Washington, D.C.
www.dykema.com
Exceptional service. Dykema delivers.
COVID-19 Vaccines In the WorkplacePresented by Elisa Lintemuth
Exceptional service. Dykema delivers.11
Background on Mandatory Vaccine Programs
Various court decisions and guidance from the EEOC and OSHA previously confirmed that employers can require employees to receive vaccinations if:
• They are job-related and consistent with business necessity; and
• They allow for:
– medical exemptions as required by the Americans with Disabilities Act (“ADA”); and
– religious objections under Title VII of the Civil Rights Act of 1964 (“Title VII”).
Exceptional service. Dykema delivers.12
ADA Accommodations
• Employees with a qualifying disability which prevents them from safely receiving the vaccine may be entitled to an exemption from a mandatory vaccine policy. Examples include:
– A serious allergy to any ingredient in the vaccine;
– A history of Guillain-Barré syndrome.
• Minor sensitivities and undocumented allergies are likely insufficient to constitute a disability under the ADA.
• The EEOC has advised that employers should accommodate a pregnant employee’s request to not to be vaccinated.
Exceptional service. Dykema delivers.13
Religious Objections
• If employees’ sincerely held religious beliefs or practices preclude them from
receiving vaccinations, they may have a valid religious objection under Title VII.
• Their beliefs do not need to be “mainstream” beliefs of any organized religion.
• The EEOC considers religious practices to include sincerely held moral or ethical
beliefs as to what is right and wrong.
• But political, medical, or intellectual beliefs opposing vaccinations do not entitle an
individual to a religious exception.
Exceptional service. Dykema delivers.14
Accommodation Requests
• If an employee requests an accommodation, the employer should engage in the interactive process.
• An employer may deny a vaccine-exemption if it can prove that it would result in an “undue hardship.”
– Religious belief under Title VII = more than de minimis cost or burden
– Disability under the ADA = significant difficulty or expense
• An accommodation that would pose a direct safety threat to employees or third parties would amount to an undue hardship.
• Employers could require an employee to follow different protective measures as an accommodation.
Exceptional service. Dykema delivers.15
Recent EEOC Guidance
• On December 16, 2020, the EEOC issued updated guidance, confirming
that an employer can require the administration of any vaccine that has
been “approved or authorized” by the FDA, as long as it provides medical
and religious exemptions.
• Vaccination itself is not a medical examination under the ADA.
– But if an employer or the employer’s third-party contractor asks an employee
pre-vaccination screening questions, those questions are likely disability-
related inquiries, which must be job-related and consistent with business
necessity under the ADA.
– To avoid these issues, employers could either: (1) offer vaccination on a
voluntary basis; or (2) require employees to show proof of vaccination from a
third party that does not have a contract with the employer.
Exceptional service. Dykema delivers.16
Recent EEOC Guidance
• Employers should conduct an individualized assessment to determine whether
an unvaccinated worker constitutes a “direct threat.”
• “The prevalence in the workplace of employees who already have received a
COVID-19 vaccination and the amount of contact with others, whose vaccination
status could be unknown, may impact the undue hardship consideration.”
• If an employer cannot provide a reasonable accommodation, the EEOC has said
“it would be lawful for the employer to exclude the employee from the
workplace.”
– However, the EEOC cautioned: “This does not mean the employer may
automatically terminate the worker. Employers will need to determine if any
other rights apply under the EEO laws or other federal, state, and local
authorities.”
Exceptional service. Dykema delivers.17
Is COVID-19 Different?
YES!
• COVID-19 is more deadly than any other communicable disease
that modern workforces have faced.
• The first COVID-19 vaccines available will have only received
Emergency Use Authorization (EUA) from the FDA.
Exceptional service. Dykema delivers.18
Emergency Use Authorization
• The EUA process is a rigorous one, but it is not supported by the same long-term
safety data required for typical FDA approval.
• The Pfizer and Moderna COVID-19 vaccines are the first vaccines authorized on an
EUA basis that have been widely distributed.
• The EUA statute states: “individuals to whom the product is administered are [to be]
informed of . . . the option to accept or refuse administration of the product, of the
consequences, if any, of refusing administration of the product, and of the
alternatives to the product that are available and of their benefits and risks.” 21
U.S.C. § 360bbb-3(e)(1)(A)(ii).
Exceptional service. Dykema delivers.19
Practical Concerns
• Employers may find that employees may react poorly to a mandatory vaccine policy.
– A recent Gallup Poll shows that only 63% of Americans would agree to be
vaccinated if an FDA-approved vaccine were available now.
– There is concern that the FDA has “fast-tracked” the vaccine and that it is not
supported by long-term safety data.
– In Michigan, all Tier 1 automotive manufacturers and large hospital systems have
reported that, at present, they are planning to encourage rather than mandate
vaccination of employees.
Exceptional service. Dykema delivers.20
Practical Concerns
• Vaccine policies should be consistently enforced so that employees are treated like similarly situated employees.
– How will your company react if a number of key employees refuse vaccination without a valid exemption?
– Is your company willing to terminate employees who refuse to comply?
• There are reports of some individuals experiencing flu-like symptoms (fever, muscle pain, chills, and headaches) after the second injection.
– Should you stagger vaccination of key employees and employees within the same department?
– Will employees refuse the second injection once they hear from others who experienced a more severe response?
Exceptional service. Dykema delivers.21
Practical Concerns
• The threat of COVID-19 is higher in senior care facilities, as the mortality rate is
much higher in the aged population.
• There will likely be a strong business case for vaccination if families look to place
their loved ones in facilities with vaccinated workforces.
• But staffing shortages could increase if you require vaccination and your workers
are unwilling to receive the vaccine.
Exceptional service. Dykema delivers.22
Practical Concerns
• Whether or not you mandate or encourage vaccination, offer employees a
trusted resource to provide knowledgeable, science-based information.
• Consider whether you will provide employees with paid time off to get
vaccinated.
• Consider whether you will require employees to use accrued leave for absences
related to an adverse reaction.
• If you are a unionized employer, review your CBA to determine whether this is a
permissive or mandatory subject of bargaining.
• Be on the look-out for employees engaging in protected concerted activity.
Exceptional service. Dykema delivers.23
Conclusion
– There is not one right answer – what is right for each employer
depends on their industry, their workforce, and the impact of
COVID-19 on their business.
– Your plan can change – e.g., encourage now and mandate later
after full FDA approval.
– Keep to date as rules and guidance change.
St. Ann’sCOVID-19
Care Recovery Center (CRC):
Overview & Lessons Learned
December 2020Executive Director Dana M. Prince, PhD
St. Ann’s COVID-19 CRCGeneral Overview
Services: St. Ann’s is a not-for-profit Catholic organization offering Assisted Living,
Skilled Nursing, and Memory Care.
Opportunity: A designated Memory Care LTC, with 10 private rooms, was converted
to an internal COVID Care Care Unit (CCU).
Mission: Fulfills the mission of the Carmelite Sister’s – received Board support as the
services reached older adults in need in our community (as well as throughout the
state).
Timing: Opened in April, with staff caring for internal COVID-positive residents until
August.
Now: Re-opened as a CRC in November for internal residents / external transfers.
Location: The unit is at the end of a clinical hallway,
separated by a fire door, which allows for physical
isolation from all residents
• Two exterior doors (1 for entry, 1 for exit)
• One interior door (used to deliver meals and
supplies – no staff allowed to enter/exit)
• Staff restroom, kitchenette, storage, and
workspaces
St. Ann’s COVID-19 CRCUnique Advantages
St. Ann’s COVID-19 CRCDedicated Staffing
Staff: Opened with a dedicated team; after conversion to CRC, monthly MDHHS stipend allowed for a wage increase to incentivize an enhanced, dedicated team
Daily: Using 12-hour shifts with 1 Nurse, 1 C.N.A., 1 Medical Support Tech, 1 RN Case Manager (days)
Other Support: Staff such as Social Work, Life Enrichment, contracted Physicians, and Therapy
Contingency: When staff test positive / emergency staffing plan enacted
St. Ann’s COVID-19 CRCEconomics & Billing
Tier 3 CRC (10 – 24 beds)Origination Stipend: $40,000• Received within 2 weeks of application acceptance; stand alone payment• Electronic Funds Transfer (the way Medicaid pays claims); must have a SIGMA
account • Informed there is now a Regional Incentive add-on (Region 6: Tier 3 = $60,000)
Monthly Stipend: $10,000• Utilize this amount for dedicated CRC staff base wage increase
Per Bed Stipend: $200/occupied bed add-on to insurance per diem • A provided document through MDHHS is given to track census (kept up-to-date
daily) based off of 10-day isolation – uploaded monthly file transfer• Some inconsistencies with county defining “Day 1” of billing
St. Ann’s COVID-19 CRCMDHHS Grant Support
Fiscal Support: St. Ann’s was awarded a one-time Infection Control Grant
• Total >$16,000
Specific fund use:• Bipolar deionizer for the HVAC system• Upgraded air handler filters (MERV 8 to MERV 13)• Touchless bathroom enhancements• Thermal scanner / health screening equipment• Tablets for each private room with wheeled mounts• UV cabinet for PPE
Photo retrieved from https://www.realtimenetworks.com/rtn-temperature-screening-solution
St. Ann’s COVID-19 CRCPPE Use and Support
PPE Use: Monitoring the burn rate that is unique to this unit; tracked separately from other units and levels of care at St. Ann’s
PPE Support: MDHHS provides PPE required to support the number of CRC staff; PPE requests are made as you run low*Received about 2-3 weeks worth of PPE
St. Ann’s COVID-19 CRCCommunity Partnerships
Infection Prevention: Early CCU development were successful in establishing rigorous infection control program with assistance and partnership at Spectrum Health’s Infectious Disease Dept.
Referrals: Incorporated similar partnership model into CRC referrals• Set up initial meetings with Mercy Health St. Mary’s and Spectrum
Health discharge planners• Created an internal, single point of contact• Single cell phone and email for CRC referrals only• Senior care organizations throughout the state (90% of our admissions
have resulted from these referrals)
St. Ann’s COVID-19 CRCInsurance and Payors
Intake System: Created a multi-disciplinary admission review & intake process
• CRC Case Manager, Finance, Social Services, & Therapy• Requiring prior authorizations from hospital discharge planners for select
managed Medicare plans before admission.• Facility-to-facility transfers: the referring facility completes the prior
authorization request for ease of admission• Some payors have not covered COVID recovery charges in our area (Grand
Rapids) making our admission requirements more stringent with regards to insurance
• Pay source is not a condition of admission (we do admit Medicaid-only patients as medically appropriate for the CRC)
St. Ann’s COVID-19 CRCCase Management
High Turnover: LOS less than 10 days
• Admissions - reviewing for those with a discharge plan• Discharges - some may need LTC. Communicate clearly with family to
reduce the potential to find alternate placement
Transfers for additional rehab care• Found success at admitting/transferring after the 10-day isolation
period into our own rehab space (general population)• Finding many of these patients need significant rehab after 10-day
isolation
St. Ann’s COVID-19 CRCCase Management
Bed Management: Keep 1-2 dedicated beds has internal bed availability for potential COVID cases
• We balance this based off of infection rates in the county and outbreaks in in-house
• Keep close monitor of pending discharge dates of CRC patients –insurance updates do pose for longer lengths of stay as appropriate and determined by the insurance case manager (e.g. NaviHealth)• Note: we do not bill the $200/occupied bed fee to MDHHS if they
exceed the 10 isolation days
• St. Ann’s residents are tested weekly for COVID due to infection rates in Kent County
Questions?
Care Recovery Unit (CRC):Overview & Lessons Learned
December 2020Executive Director Dana M. Prince, PhD
