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Page 1 of 19 © Alabama Nursing Home Association
Weekly Roundup …Reporting the state and national long-term care news
Please disseminate relevant information to the appropriate department.
Administration Nursing Dietary Activities Social Services
Rehabilitation Housekeeping Maintenance Laundry
• @
Friday, May 8, 2020
The Alabama Nursing Home Association has a webpage dedicated to COVID-19 which is
updated throughout the week. Go to anha.org/covid19. Information is arranged by category.
ANHA WEBINAR
ANHA Webinar: OSHA Enforcement during COVID-19 The Alabama Nursing Home Association is partnering with Starnes Davis Florie, LLP to present
the webinar:
Another Threat to Your Facility: OSHA’s Approach to Enforcement During the COVID-
19 Pandemic.
Tuesday, May 12, 2020, 1:00-2:00 p.m. Central
Click here to register
The Occupational Health & Safety Administration (OSHA) has been active both nationally and
locally during the COVID-19 pandemic. Its enforcement efforts have openly focused on health
care facilities, particularly nursing homes, through informal complaints, rapid response
investigations and formal inspections. This hour-long webinar will cover OSHA’s interim rules
and guidance, current trends in OSHA enforcement, areas of emphasis with COVID-19 and
strategies to protect your business from an OSHA citation.
Target Audience: Administrators, safety officers and interested health care professionals who
deal with OSHA.
CEU Credit: This program is approved by the Alabama Board of Nursing Home Administrators
for one (1) hour of CEU credit.
Registration Fee: The registration fee is $25.00 per registration. Only registered individuals will
be eligible for the nursing home administrator CEU.
See the attached flyer for more details.
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STATE NEWS
Gov. Ivey Issues National Skilled Nursing Care Week Proclamation Governor Kay Ivey has issued a proclamation to declare National Skilled Nursing Care Week in
Alabama. The week begins on Mother’s Day, Sunday, May 10 and ends Saturday, May 16. A
copy of Gov. Ivey’s proclamation is attached.
Absentee Voting Information Alabama’s primary runoff election is July 14, 2020. Below are important deadlines leading up to
election day. For more information, visit https://www.sos.alabama.gov/alabama-votes.
• Monday, June 29, 2020 Deadline to register to vote
• Thursday, July 9, 2020 deadline to submit an absentee ballot application
• Monday, July 13, 2020 deadline to return or postmark an absentee ballot
• Tuesday, July 14, 2020 Primary Runoff Election
CMS Releases Memo on Interim Final Rule Updating Requirements for
Reporting and Notification of Confirmed and Suspected COVID-19 Cases
Among Residents and Staff in Nursing Homes The Centers for Medicare and Medicaid Services (CMS) released a QSO memo addressing the
Interim Final Rule requiring nursing homes to report to NHSN on COVID-19 as well as provide
notifications to residents, their representatives and families.
Some highlights from the memo are listed below. There are some important implementation
dates members need to know.
CMS had previously communicated the effective date was May 1. However, CMS revised the
effective date to be May 8, 2020.
• The effective date means nursing homes are required to begin notifications of residents, their
representatives and families as of May 8. This means the first notification could be required
to occur by May 9 at 5 pm, should the facility have any of the resident and/or staff cases on
May 8 as described by CMS required to make notification.
• Action: Ensure system and processes for notifications are in place in your facility by May 8
to meet new requirements.
Facilities must submit their first set of data by 11:59 pm on Sunday, May 17, 2020, to the
NHSN Long-Term Care Facility COVID-19 Module.
• Action: Register now for NHSN and begin collecting data starting May 8, 2020. [NOTE:
registration is taking more time than expected and we encourage you to start now to avoid
further delays that may impact your compliance.]
o The memo provides an overview of the registration process.
o For NHSN questions, please email: [email protected] and add “LTCF” in the subject
header.
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CMS will provide facilities with an initial two-week grace period to begin reporting cases in
the NHSN system (which ends at 11:59 p.m. on May 24, 2020). Facilities that do not begin
reporting after the third week (by 11:59 pm on May 31, 2020) will receive a warning letter
reminding them to begin reporting the required information to the CDC.
For facilities that have not started reporting in the NHSN system by 11:59 p.m. on June 7, ending
the fourth week of reporting, CMS will impose a per day (PD) CMP of $1,000 for the failure to
report that week.
For each subsequent week that the facility fails to submit the required report, the noncompliance
will result in an additional one-day PD CMP imposed at an amount increased by $500.
For enforcement-related questions, please email: [email protected].
New COVID-19 F-tags & Updated Survey Tools
CMS has established two new F-Tags - F884: COVID-19 Reporting to CDC and F885 COVID-
19 Reporting to Residents, their Representatives, and Families.
CMS has updated survey tools including COVID-19 Focused Survey for Nursing Homes,
Entrance Conference Worksheet, COVID-19 Focused Survey Protocol, and Summary of the
COVID-19 Focused Survey for Nursing Homes. These updated forms are posted to the Survey
Resources folder in the COVID-19 Focused Survey sub-folder on the CMS Nursing Homes
website. You can find a link to the folder in the QSO memo.
• Action: Facilities should begin using the revised “COVID-19 Focused Survey for Nursing
Homes” to perform their self-assessment. Surveyors will begin using these revised
documents immediately.
Public Posting of NHSN Data Anticipated by the End of May
CMS anticipates publicly posting CDC’s NHSN data (including facility names, number of
COVID-19 suspected and confirmed cases, deaths, and other data as determined appropriate)
weekly on Monday’s at https://data.cms.gov/ by the end of May.
Multiple Q&A
CMS provides 22 Q&A in the last seven pages of the memo. Question 10 addresses retrospective
reporting and reads as below:
• Q: Are facilities required to report data that predates the effective date (May 8) of the interim
final rule?
• A: No, there is no requirement in the rule to collect older data.
CMP Grants for Adaptive Communicative Technology - UPDATE The Alabama Nursing Home Association (ANHA) was informed by the Alabama Department of
Public Health that Civil Money Penalty (CMP) funds may be used to provide residents with
adaptive communicative technologies. The ANHA encourages you to read these documents and
apply for assistive technology via CMP grants. CMS requests that all application include the
brand and model of the device and the process used for disinfection (must be on the EPA N list.)
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CMS also asks for an average daily census. Completed forms should be emailed to Dennis Blair
at ADPH, [email protected].
Click here for the CMP application template
Click here for the Application FAQs
In order to receive the funds from the CMP account facilities will have to register an account in
STAARS. The vendor is to go procurement.staars.alabama.gov and set up a VSS account.
Once you have an approved Vendor number you can submit an invoice to Robin Arrington at
[email protected]. A sample invoice is attached. Please make sure that you send
the CMP Grant Template and the approval from ADPH with your invoice!
Ms. Alabama Nursing Home Pageant Canceled Due to the ongoing COVID-19 pandemic, the ANHA Executive Board voted to cancel the 2020
Ms. Alabama Nursing Home Pageant. The event was originally scheduled for July 27, 2020.
Please Notify ANHA of COVID-19 Cases Please notify the Alabama Nursing Home Association if your facility has a resident or staff
member diagnosed with COVID-19. Email Katrina Magdon, [email protected], and John
Matson, [email protected]. Thank you for your assistance.
Also, you may refer media questions to John, and contact Katrina with your regulatory questions.
ADPH Reminder on Reporting COVID-19 Cases The Alabama Department of Public Health reminds everyone that facilities are responsible for
reporting suspected COVID-19 to their local Health Department. If a facility is suspicious
enough to test, it needs to report. The ADPH Bureau of Health Provider Standards would also
appreciate a courtesy notification as well to Mia Sadler, [email protected], and Lisa
Pezent, [email protected].
Alabama National Guard to help sanitize nursing homes, train staff
The Alabama Army National Guard is helping nursing homes respond to COVID-19.
Specially trained National Guard teams will perform two tasks:
1. Sanitize and disinfect nursing homes that have COVID-19 positive residents and/or
employees.
a. The National Guard teams will have their own PPE and cleaning supplies.
b. Their service is provided at no cost to your nursing home.
c. The service does not include rooms/areas that house COVID-19 positive residents
or those under quarantine. However, cleaning of those made possibly be arranged
on a case-by-case basis.
2. Train nursing home staff on the proper way to don and doff personal protective
equipment (PPE).
Here’s how the process will work:
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• An Alabama Nursing Home Association staff member will contact you to ask if your
facility wants the Alabama Army National Guard’s assistance. Or, you may email Kerri
Parker, [email protected], and tell her you want this service.
• If you want this free service, a member of the Alabama Army National Guard will
contact you to discuss further details and schedule the cleaning/training.
• The National Guard team will perform the services on the scheduled date.
More UPDATES Related to COVID-19 Trump Administration Issues Second Round of Sweeping Changes to Support U.S.
Healthcare System During COVID-19 Pandemic
The IFC outlines actions CMS is taking to ensure states and localities have the flexibilities they
need to ramp up diagnostic testing and access to medical care, key precursors to ensuring a
phased, safe, and gradual reopening of America.
Fact Sheets
CMS has updated multiple fact sheets that summarize changes made through regulatory actions
in response to COVID-19. View more resources available on CMS waivers and flexibilities here.
A full list of emergency declaration blanket waivers for health care providers implemented to
date is available here. Additional fact sheets include:
• Clinicians:
o Physicians and Other Practitioners (PDF)
• Hospitals and Facilities:
o Hospitals (PDF)
o Teaching Hospitals, Teaching Physicians and Medical Residents (PDF)
o Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities)
(PDF)
o Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
(PDF)
o Long Term Care Hospitals & Extended Neoplastic Disease Care Hospitals (PDF)
o Inpatient Rehabilitation Facilities (PDF)
o End Stage Renal Disease (ESRD) Facilities (PDF)
• Service providers:
o Home Health Agencies (PDF)
o Hospices (PDF)
o Durable Medical Equipment (PDF)
o Laboratories (PDF)
o Ambulances (PDF)
• Other CMS Programs:
o Medicare Advantage and Part D Plans (PDF)
o Medicaid & Basic Health Programs
o Medicare Shared Savings Program Participants (PDF)
o Participants in the Medicare Diabetes Prevention Program (PDF)
Laboratory and Testing and Resources
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CMS is committed to taking critical steps to ensure America’s clinical laboratories can respond
to the threat of COVID-19 and other respiratory illnesses to ensure patient health and safety.
• Memo to State Survey Agencies
• List of lab test codes for COVID-19, Influenza, RSV (PDF) (4/30/20)
CDC Adds Links To COVID-19 Site
Please make a note of the following resource links that are now live on the CDC website:
• Responding to Coronavirus (COVID-19) in Nursing Homes
• Testing for Coronavirus (COVID-19) in Nursing Homes
Certain Asymptomatic, High-Risk People Can Now be Tested for COVID-19
at the State’s Bureau of Clinical Laboratories The Alabama Department of Public Health Bureau of Clinical Laboratories has expanded the
criteria to test for COVID-19 to add testing for certain asymptomatic, high-risk groups and
individuals.
By widening the conditions to test high-risk people before symptoms appear, the risk of
continued transmission of the virus is lessened and timely case investigations and contact tracing
can begin earlier. The Centers for Disease Control and Prevention made these recommendations.
Symptoms of COVID-19 consist of either cough or shortness of breath (difficulty breathing) or
at least two of the following: fever, chills, repeated shaking with chills, muscle pain, headache,
vomiting, diarrhea, sore throat, and new loss of taste or smell.
New testing criteria are as follows:
The patient is a resident (includes symptomatic and asymptomatic) of a long-term care facility
and the facility has laboratory-confirmed cases in residents or staff, or are
• Hospitalized patients with symptoms
• Healthcare facility workers, workers in congregate living settings, and first responders with
symptoms
• Residents in long-term care facilities or other congregate living settings, including
correctional and detention facilities and shelters, with symptoms
• Persons without symptoms who have underlying medical conditions or disability placing
them at a higher risk of complications, residency in a congregate housing setting such as a
homeless shelter or long-term care facility, or screening of other asymptomatic individuals
based on a case-by-case review and approval by the state health department or local health
jurisdiction.
Providers may order testing for persons not meeting the above criteria but are asked to use a
commercial or clinical laboratory with which they have an agreement. For more information,
visit alabamapublichealth.gov.
Medicaid Add-On – Hospice Provider Reminder With the add-on from Medicaid, (https://medicaid.alabama.gov/alert_detail.aspx?ID=13842) the
Alabama Nursing Home Association thinks it is a good idea to remind hospice providers that
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they have to turn those additional funds over to the nursing homes. Below is a draft letter the
ANHA recommends you send to your hospice providers.
“Dear Hospice Provider:
Thank you for being a valued hospice provider to our nursing home residents. Under the current
circumstances with the COVID-19 pandemic, we have restricted visitation to only essential
workers. Pursuant to CMS and CDC guidelines, we are prohibiting hospice providers from
entering our building except for limited circumstances. We appreciate your understanding and
cooperation during this difficult time.
Based on our contract, Nursing Home charges Hospice room and board for Medicaid residents at
the Nursing Home’s Medicaid daily room rate. Hospice is required to compensate the Nursing
Home for a resident’s room and board at one hundred percent (100%) of the Nursing Home’s
room and board Medicaid reimbursement rate, minus any resource amount due by
resident/family for covered room and board services.
As you may know, under a State Plan Amendment, Medicaid has made a $20 per day increase in
its per diem payment to nursing facilities effective 3/1/2020 for all Medicaid patients. This will
continue through the COVID-19 emergency period. Because you receive these payments for our
hospice patients, we wanted you to be aware of this increase and request that you reimburse the
facility the entire Medicaid payment plus the per diem increase. The increase is intended to
compensate nursing facilities for providing extra COVID related services during this COVID-19
pandemic and nursing facilities will have to account to Medicaid for the use of these funds.
Should you have any questions regarding our request, please feel free to reach out to [ ].”
VA Suspends Transitions to New Systems Due to COVID-19 The VA recently announced that their transition to HealthShare Referral Manager (HSRM) and
Electronic Claims Administration Management System (eCAMS) for the Community Nursing
Home (CNH) program has been suspended until further notice due to COVID-19. As a result of
this suspension, the following actions are required:
1. Non-CCN CNH authorizations should continue to be issued through VistA. Any
authorizations for non-CCN CNH made through HSRM need to be reissued through
VistA, according to the guidance provided by the Office of Geriatrics and Extended Care
dated April 2, 2020.
2. CNH providers need to be notified to continue to send CNH claims via paper directly to
VA medical centers (VAMC) under previously established processes. CNH claims
should not be sent via electronic data interchange (EDI) to VA at this time.
Additional training and guidance are being developed for VA staff and CNH providers, and will
be announced once the transition to HSRM and eCAMS restarts.
PPE Scams Are Abundant, Particularly for N-95 Shortages of PPE such as N95 respirators persist. However, there is no shortage of non-medical
suppliers and distributors that claim to have N95 and KN95 masks and other PPE for sale. Many
of the sales calls come from third party representatives claiming to have ready access to PPE. Be
cautious and ask yourself, “Why does this non-medical distributor have access to PPE when the
major medical distributors and suppliers that I have used in the past do not?”
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Be on the lookout for these BIG red flags when contacted by these salespersons:
• Emails that come from personal email accounts such as Gmail or Yahoo accounts.
• No last name from the sender or company contact information in the email, including a
website that you independently can verify through a web search engine.
• Pressure tactics such as “you must place your order and pay today/now if you want to get
your order in the next shipment.”
• A requirement that you must pay up front to place your order usually through wire
transfers, direct transfers from your bank accounts, PayPal or Venmo.
When working with a new supplier, ask for references of other long-term care providers who
have ordered from the company and had the PPE delivered. Then, independently check those
references. Read more complete guidance on avoiding scams. We continue to recommend
working with existing suppliers or contacting your state agency for PPE.
Decontamination of N95 Masks Listed below is the process to follow regarding the N95 decontamination.
How to initiate Battelle N95 Decontamination:
Step 1: Download the Services Agreement, (downloads as Microsoft Word document) have your
authorized representative sign it and return by email to
[email protected]. We will issue back a countersigned agreement.
Step 2: Once your signed services agreement has been sent, download and complete the Site
Locations and POC Information form (downloads as Microsoft Excel spreadsheet) and return by
email to Ben Presson [email protected].
Note: Each row of data in the excel sheet should be for a physical location at which you would
like to send and receive masks. Example a countywide fire department would want to put in a
line for each firehouse so each can send and receive masks directly.
Step 3: 3-digit site codes for each location will be provided to you after the services agreement is
executed. The 3-digit codes are to be marked on each N95 respirator you collect. Begin
collecting and labeling your N95 respirators. Each N95 respirator must be handled and labeled
properly to be decontaminated. Below are specific instructions for details on how to collect,
label, and package your respirators for shipment.
• Instructions for Healthcare Personnel (mask marking)
• Instructions for Healthcare Facilities
• HCP - Fact Sheet
It is VERY IMPORTANT that every N95 is properly labeled and free of any visible soiling
such as blood, bodily fluids, and makeup. They can’t decontaminate N95s that do not meet these
requirements.
Step 4: SEND MASKS! When you prepare to send your N95s, you will need to download and
fill out the Chain of Custody Form (downloads as Microsoft Excel spreadsheet). Please provide
one form per shipment.
Other important details about the service are located in the Battelle CCDS™ FAQs.
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Further Details:
Under the EUA from the FDA, Battelle is only able to accept non-cellulose, NIOSH-approved
N95 respirators and certain imported, non-NIOSH respirators. Below are links to CDC/FDA
resources to check and see if your respirators are compatible with our system:
• NIOSH-approved respirators
• Imported respirators
Please view the enclosed document regarding the process offered to Alabama facilities regarding
decontamination of N95 Masks.
Updated CDC Guidance Released on Return to Work and Clinical Care The Centers for Disease Control and Prevention (CDC) released two updated guidance around
criteria for returning to work for healthcare personnel (HCP) with confirmed or suspected
COVID-19 and the discontinuation of transmission-based precautions and disposition of patients
with COVID-19.
1. Updated Criteria for Return to Work for HCP with Confirmed or Suspected COVID-
19 - Decisions about return to work for HCP with confirmed or suspected COVID-19 should be
made in the context of local circumstances. This updated guidance includes the following:
• Changed the name of the ‘non-test-based strategy’ to the ‘symptom-based strategy’ for
those with symptoms and the ‘time-based strategy’ for those without symptoms
• Updated these to extend the duration of exclusion from work to at least 10 days
(previously 7 days) since symptoms first appeared.
The CDC specifically notes that after returning to work, HCP should:
• Wear a facemask for source control at all times while in the healthcare facility until all
symptoms are completely resolved or at baseline. After this time period, these HCP
should revert to their facility policy regarding universal source control during the
pandemic.
• Self-monitor for symptoms and seek re-evaluation from occupational health if respiratory
symptoms recur or worsen.
CDC also has information focused around strategies to mitigate healthcare personnel staffing
shortages you might be interested in reviewing.
2. Updated Discontinuation of Transmission-Based Precautions and Disposition of Patients
with COVID-19 in Healthcare Settings - This updated guidance includes the following:
• Changed the name of the ‘non-test-based strategy’ to the ‘symptom-based strategy’ for
those with symptoms and the ‘time-based strategy’ for those without symptoms, and
updated these to extend the duration of Transmission-Based Precautions to at least 10
days (previously 7 days) since symptoms first appeared.
• Added criteria for discontinuing Transmission-Based Precautions for patients who have
laboratory-confirmed COVID-19 but have not had any symptoms of COVID-19.
According to the CDC, if a patient is discharged to a nursing home or other long-term care
facility (e.g., assisted living community), AND transmission-based precautions:
• are still required, they should go to a facility with an ability to adhere to infection
prevention and control recommendations for the care of COVID-19 patients. Preferably,
the patient would be placed in a location designated to care for COVID-19 residents.
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• have been discontinued, but the patient has persistent symptoms from COVID-19 (e.g.,
persistent cough), they should be placed in a single room, be restricted to their room to
the extent possible, and wear a facemask (if tolerated) during care activities until all
symptoms are completely resolved or at baseline.
• have been discontinued and the patient’s symptoms have resolved, they do not require
further restrictions, based upon their history of COVID-19.
The Alabama Department of Public Health (ADPH) has removed the previous document entitled
“Isolation and Quarantine Timeframes for COVID-19”. All references for return to work for
Healthcare Personnel now refer to the CDC website at https://www.cdc.gov/coronavirus/2019-
ncov/hcp/return-to-work.html. In addition, guidance has been released from CDC in regards to
Symptom-Based Strategy to Discontinue Isolation for Persons with COVID-19 which can be
found at https://www.cdc.gov/coronavirus/2019-ncov/community/strategy-discontinue-
isolation.html.
CMS Issues Claims Processing Guidance Related to New COVID-19 ICD-10
Code The American Health Care Association (AHCA) reported to the Centers for Medicare and
Medicaid Services (CMS) an apparent glitch with implementing the U07.1 - 2019-nCoV acute
respiratory disease ICD-10 CM code when the five-day assessment window overlaps March into
April dates of service.
For example, when the MDS assessment reference date (ARD) is in April [4/1/20], but the date
of service (DOS) is in March [3/25-3/31]. This is creating a problem given the U07.1 code is
valid as primary in the MDS grouper April 1 but not on the UB-04 for DOS prior to April 1.
Specifically, this is creating a primary diagnosis conflict whereby providers cannot match the
primary diagnosis on the UB-04 in form locator 67 with the primary reason for skilled care in
item I0020B of the MDS.
CMS has provided the following standardized guidance to the MACs:
“Based on the following guidance from the CMS PDPM FAQs (PDPM FAQs and PDPM FAQs
Redline) question 1.8 is to tell providers with a 5-Day PPS MDS with an April 2020 ARD, but a
lookback period that extends into March 2020 that, when applicable, they can use the COVID 19
ICD-10 code U07.1 in MDS item I0020B to obtain the appropriate PDPM case-mix
classification, but that the claim associated with March DOS must contain a different ICD-10
code that applies to the beneficiary and that was valid in March.
“We understand that this is a one-time event that only impacts a relatively small number of
admissions related to COVID-19 that spanned the March-April implementation of the new U07.1
diagnosis code. The claim will need to contain a different diagnosis other than U07.1 but the
assessment may contain U07.1 code in these instances.”
Coronavirus Pandemic Response: PPE Packages for Nursing Homes Under the direction of the White House Coronavirus Task Force, FEMA will coordinate two
shipments totaling a 14-day supply of personal protective equipment (PPE) to more than 15,000
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nursing homes across the Nation. The mission will supplement existing efforts to ensure nursing
homes across the country have PPE during the coronavirus (COVID-19) pandemic. FEMA will
ship PPE to Medicaid- and Medicare-certified nursing homes based on input from the American
Health Care Association to serve as a bridge between other PPE shipments.
1. Each nursing home will receive two shipments with a combined total of 14 days’ worth
of PPE.
2. Shipments of the first seven-day supply are expected to begin the first week of May.
3. Shipments of an additional seven-day supply will begin in early June.
4. The first shipments will focus on facilities within prioritized hotspots and expand to
facilities across all 50 states, the District of Columbia, Puerto Rico, and Guam.
5. The total estimated amount of PPE includes more than 7.1 million surgical masks, nearly
32.3 million gloves, more than 922,000 goggles and other eye protection, and nearly 9.7
million gowns.
6. Each facility will receive an allotment of all four items based on the staff size of the
facility, which ranges from fewer than 10 employees to nearly 500.
7. The level 1 medical gowns included in the shipments are intended for use in basic care
settings for minimal risk situations. The gowns are durable and can be washed 30 to 50
times.
8. Due to the large number of nursing homes, facilities are not likely to receive notification
prior to their shipment arriving. However, as possible, FEMA will provide notification to
a state prior to shipments arriving at their Medicaid/Medicare-certified facilities.
9. The distributor that was awarded the contract to deliver these supplies is not involved
with FEMA Project Airbridge initiative. Rather, this effort taps into the smaller
operations that have supplies of various items in high demand, such as the level 1 medical
gowns.
10. Due to the critical need for PPE at nursing homes where some of our Nation’s most
vulnerable residents live, these supplies are meant to supplement existing PPE efforts by
the federal government. FEMA and HHS continue working with states, territories, and
tribes on PPE needs through a variety of ways.
PPE Burn Rate Calculator - Mobile App The Personal Protective Equipment (PPE) Burn Rate Calculator is now available as a mobile
app. Facilities can use the NIOSH PPE Tracker app to calculate their average PPE consumption
rate or “burn rate.” The app estimates how many days a PPE supply will last given current
inventory levels and PPE burn rate. For the excel version, please visit the CDC website.
To Access PPE, You Must Activate Your Facility’s AIMS Account In order to ensure your PPE needs are known to the Alabama Department of Public Health
(ADPH), you must enter your PPE needs into the Alabama Incident Management System
(AIMS) system. The health care facilities who enter their PPE needs into the AIMS system get
priority as PPE is distributed throughout the state. If you have an immediate need, contact your
local EMA to inquire if it has any supplies. Currently, the ADPH has distributed all the PPE
from its warehouse. More shipments have arrived but must be tested in ensure these vital items
are not faulty.
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If you have not already done so, log-in and activate your facility’s AIMS account. AIMS is
operated by the ADPH and the University of South Alabama to coordinate health care services
and needs during declared emergencies and disasters. Each nursing home has an AIMS account.
If you don’t know your facility’s account information, contact the AIMS Coordinator at your
local Healthcare Coalition (HCC). Click here for a list of the local AIMS Coordinators.
Nurse Aide Abuse Registry Please note that the following individual has been placed on the Alabama Nurse Aide Abuse
and/or Sanction Registry. This individual is prohibited from working in any long-term care
facility. To check nurse aides, you can use the nurse aide web site at www.adph.org (Click on
Contents A-Z - located in the dark blue at the top of the screen - then Click on Nurse Aide
Registry - then Click in the white box and type in the Social Security Number of the person you
are trying to find. Be sure and include the dashes in the SSN.)
Name Effective Date
Connie Dunning 05/06/2020
NATIONAL NEWS
DHHS Extends Attestation Window for CARES Act Provider Relief Fund Earlier this week, U.S. Department of Health and Human Services (DHHS) noted that if the
Department was unable to prepare updated FAQs and new guidance for fund recipients, the
CARES Act Provider Relief Fund attestation window would be extended. In the early release
press statement below, DHHS announces that the attestation window and related acceptance of
Terms and Conditions has been extended by 45 days, formerly 30 days, from the date a provider
received a payment to attest to and accept the Terms and Conditions or return the funds.
Members will need to identify the date of their initial funding relief payment and identify their
new attestation and Terms and Conditions acceptance date based on the extension. Below,
DHHS offers an example of how the extension of the window will be operationalized.
Next Steps
The American Health Care Association (AHCA) will continue to submit questions and examples
of challenging fund scenarios to DHHS including Change in Ownership (CHOW), Tax
Identification Number (TIN) aggregation, disaggregation, or lack of TIN arrangements,
additional questions about financial terminology and use of tax filing data for validation. If you
have questions for submission to DHHS, please submit your requests to [email protected].
HHS Extends Deadline for Attestation, Acceptance of Terms and Conditions
for Provider Relief Fund Payments to 45 Days
The Department of Health and Human Services has extended the deadline for healthcare
providers to attest to receipt of payments from the Provider Relief Fund and accept the Terms
and Conditions. Providers will now have 45 days, increased from 30 days, from the date they
receive a payment to attest and accept the Terms and Conditions or return the funds. As an
example, the initial 30-day deadline for providers who received payment on April 10, 2020, is
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extended to May 24 from May 9, 2020. With the extension, not returning the payment within 45
days of receipt of payment will be viewed as acceptance of the Terms and Conditions.
President Trump is providing support to healthcare providers fighting the COVID-19 pandemic
through the bipartisan CARES Act and Paycheck Protection Program and Health Care
Enhancement Act which provide $175 billion in relief funds to hospitals and other healthcare
providers on the front lines of the coronavirus response. This funding will be used to support
healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured
Americans can get treatment for COVID-19.
In allocating the funds, the Administration is working, among other things, to address both the
economic harm across the entire healthcare system due to the stoppage of elective procedures
and addressing the economic impact on providers particularly impacted by COVID-19, and to do
so as quickly and transparently as possible.
Visit hhs.gov/providerrelief for more information on the allocations. Recipients of payments
from any of these allocations must attest and accept the Terms and Conditions within 45 days.
• HHS is distributing $50 billion across the healthcare system to providers and facilities that
bill Medicare.
• Recognizing the financial strain from COVID-19 inpatient admissions, HHS is distributing
$12 billion to hospitals that reported at least 100 COVID-19 inpatient admissions through
April 10 to HHS.
• HHS is distributing $10 billion to rural hospitals and clinics.
• HHS is distributing $400 million to tribal healthcare providers.
• HHS is using a portion of the Provider Relief Fund to reimburse healthcare providers, at
Medicare rates, for COVID-related treatment of the uninsured.
• HHS is working to provide relief to additional healthcare providers including skilled nursing
facilities, dentists, and other providers significantly impacted by COVID-19.
DHHS Clarifies CARES Act Provider Relief Fund Questions In the past weeks, the American Health Care Association (AHCA) has submitted an array of
questions on the Provider Relief Fund. Of particular importance, health care providers have
expressed concern about interplay among the April 10 and 17 allocations with the second
distribution that began on April 24. The primary concern has been that if a “gross receipts”
methodology is applied across both tranches; providers might have to give back some of the
money even if they have sufficient COVID-related expenses or lost revenues.
Recently, the U.S Department of Health and Human Services (DHHS) staff has indicated
they do not intend to recover Provider Relief Fund allocations unless:
1. DHHS identifies an overpayment associated with revenue calculations which were incorrect
based upon improper or incorrect information on the cost reports. DHHS also noted the
Department is collecting tax filing information to be uploaded to verify the revenue.
AHCA/NCAL recognizes the challenges associated with using tax filing information and is
conveying those concerns to the Department; and
2. DHHS will pursue providers who cannot substantiate the costs/loss of revenue. AHCA has
developed a COVID-19 Loss/Cost Calculator (member login required).
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Background
DHHS based the April 10 and 17 allocations on a provider’s 2019 Medicare fee-for-service
claims data. Providers received approximately 6.2% of that amount with an intended total of $30
billion across the whole Medicare program. Of the $30 billion, $26 billion was distributed on
April 10 and $4 billion on April 17.
On April 24, DHHS released the second tranche based on 2% of the providers “net patient
revenue” for 2018. Use of the term “net patient revenue” created confusion while the attestation
web portal notes “Gross Receipts or Sales.” It appears, DHHS’ intent is gross receipts as a tax
return term which indicates revenue after deductions such as contractual allowances, which are
customary in health care.
An additional concern associated with the attestation language is the term “overpayment.”
DHHS has indicated that “overpayment” is meant to address situations where fund distribution
calculation is in error. Specifically, this portion of the requested data is intended to provide
DHHS with data to account for misalignment of a Tranche 1 award with Medicare fee-for-
service net revenues or Tranche 2 payments based on 2018 cost report data.
DHHS will be issuing an FAQ to clarify the Tranche 1 and 2 payment concerns and to address
AHCA/NCAL questions such as Change in Ownership (CHOW) and problematic Tax
Identification Number (TIN) scenarios (e.g., single TIN for multiple sources of revenue or
businesses, no TIN if county owned, etc.). If they are unable to finalize the FAQ in time to have
providers submit an attestation by the 30-day deadline, DHHS will extend the deadline.
AHCA Member Support
The Association will be developing an array of member support materials once DHHS releases
the updated materials. These will include:
1. Strategies to Address DHHS Overpayment Scenarios Described in items 1 and 2, above;
2. Updated AHCA/NCAL Grant and Loan Management Guide; and
3. Provider Relief Fund Reporting Template.
Additionally, the Association will continue to pursue questions and concerns associated with
using data such as tax filings.
CMS Issues Additional Blanket Regulatory Waivers The Centers for Medicare and Medicaid Services (CMS) has issued several new blanket waivers
for long-term care providers. The following blanket waivers are in effect, with a retroactive
effective date of March 1, 2020, through the end of the emergency declaration. We also offer a
summary below.
New Blanket Waivers
Quality Assurance and Performance Improvement (QAPI)
CMS is modifying certain QAPI program requirements—specifically, §483.75(b)–(d) and
(e)(3)—to the extent necessary to narrow the scope of the QAPI program to focus on adverse
events and infection control.
The following sections are waived:
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• §483.75(b) Program design and scope, which includes “address all systems of care and
management practices”;
• §483.75(c) Program feedback, data systems and monitoring;
• §483.75(d) Program systematic analysis and systemic action; and
• §483.75(e)(3) Performance improvement projects.
In-Service Training
CMS is modifying the requirement that the nursing assistant must receive at least 12 hours of in-
service training annually by postponing the deadline for completing this requirement until the
end of the first full quarter after the declaration of the COVID-19 Public Health Emergency
concludes.
Detailed Information Sharing for Discharge Planning for Long-Term Care (LTC) Facilities
CMS is waiving the discharge planning requirement which requires LTC facilities to assist
residents and their representatives in selecting a post-acute care provider using data, such as
standardized patient assessment data, quality measures and resource use. CMS is maintaining
all other discharge planning requirements, including the discharge plan.
Clinical Records
CMS is modifying the requirement which requires LTC facilities to provide a resident a copy of
their records within two working days (when requested by the resident) by allowing facilities ten
working days to provide the requested record.
Inspection, Testing & Maintenance (ITM) under the Physical Environment
CMS is waiving certain physical environment requirements for providers including ICF/IIDs
and SNFs/NFs to the extent necessary to permit facilities to adjust scheduled inspection, testing
and maintenance (ITM) frequencies and activities for facility and medical equipment required by
the Life Safety Code (LSC) and Health Care Facilities Code (HCFC.)
The following LSC and HCFC ITM are considered critical and are not included in this
waiver:
• Sprinkler system monthly electric motor-driven and weekly diesel engine-driven fire pump
testing.
• Portable fire extinguisher monthly inspection.
• Elevators with firefighters’ emergency operations monthly testing.
• Emergency generator 30 continuous minute monthly testing and associated transfer switch
monthly testing.
• Means of egress daily inspection in areas that have undergone construction, repair, alterations
or additions to ensure its ability to be used instantly in case of emergency.
ICF/IIDs, and SNFs/NFs are required to have an outside window or outside door in every
sleeping room. CMS will permit a waiver of these outside window and outside door
requirements to permit these providers to use facility and non-facility space that is not normally
used for patient care for temporary patient care or quarantine.
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Note: Be aware that federal waivers such as these may not be applicable to state and/or local
Authorities Having Jurisdiction (AHJs).
Updates to Previously Issued Regulatory Blanket Waivers CMS updated some language to blanket waivers that were previously issued at the end of March.
Resident Transfer and Discharge
CMS continues to waive requirements to allow a LTC facility to transfer or discharge residents
to another LTC facility solely for the following cohorting purposes. Scenario two has added
language regarding resident’s care plans in bold below.
1. Transferring residents with symptoms of a respiratory infection or confirmed diagnosis of
COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to
the care of such residents;
2. Transferring residents without symptoms of a respiratory infection or confirmed to not have
COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to
the care of such residents to prevent them from acquiring COVID-19, as well as providing
treatment or therapy for other conditions as required by the resident’s plan of care; or
3. Transferring residents without symptoms of a respiratory infection to another facility that
agrees to accept each specific resident to observe for any signs or symptoms of a respiratory
infection over 14 days.
Waive Pre-Admission Screening and Annual Resident Review (PASARR)
CMS is allowing nursing homes to admit new residents who have not received Level 1 or Level
2 Preadmission Screening. Level 1 assessments may be performed post-admission. On or before
the 30th day of admission, new patients admitted to nursing homes with a mental illness (MI) or
intellectual disability (ID) should be referred promptly by the nursing home to State PASARR
program for Level 2 Resident Review.
Note: This language is included in the summary waiver list for all providers and differs slightly
from the text in the LTC specific waiver summary.
Updates to Previously Issued Reimbursement Blanket Waivers CMS Facility without Walls (Temporary Expansion Sites) – Transfer of COVID Patients
• The transferring SNF need not issue a formal discharge in this situation, as it is still
considered the provider and should bill Medicare normally for each day of care.
• The transferring SNF is then responsible for reimbursing the other provider that accepted its
resident(s) during the emergency period.
• Processing Manual
• View a CMS QSO memo on transfers
Cost Report Delay
• CMS will delay the filing deadline of FYE 10/31/2019 cost reports due by March 31, 2020
and FYE 11/30/2019 cost reports due by April 30, 2020. The extended cost report due dates
for these October and November FYEs will be June 30, 2020.
• CMS will also delay the filing deadline of the FYE 12/31/2019 cost reports due by May 31,
2020. The extended cost report due date for FYE 12/31/2019 will be July 31, 2020.
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Telehealth
• CMS is waiving the requirements of section 1834(m)(4)(E) of the Act and 42 CFR § 410.78
(b)(2) which specify the types of practitioners that may bill for their services when furnished
as Medicare telehealth services from the distant site.
• This waiver expands the types of health care professionals that can furnish distant site
telehealth services to include all those that are eligible to bill Medicare for their professional
services.
• This allows health care professionals who were previously ineligible to furnish and bill for
Medicare telehealth services, including physical therapists, occupational therapists, speech
language pathologists, and others, to receive payment for Medicare telehealth services.
• May impact SNFs that furnish outpatient therapy in AL, IL, and the community. CMS did
not provide billing guidance – AHCA recommends SNF providers contact their MAC for
guidance.
CMS Delays Implementation of New MDS Items (Transfer of Health Information and
Certain SPADES) Adopted for the SNF QRP for 2 Years
The Interim final rule from CMS also delays implementation of new MDS items for SNF QRP as
described below:
• This delay will enable SNFs to continue using the current version of the MDS 3.0 v1.17.1
• CMS will require SNFs to collect data on the transfer of health information measures and
SPADES data on October 1 of the 1st of the year that is at least two full fiscal years after the
end of the COVID-19 public health emergency.
• CMS will work with SNFs prior to implementation to address questions related to training
and software update needs.
Comments are due 60 days after date of publication in the Federal Register.
AHCA is reviewing this rule in detail and will share further information as soon as it is available.
In the meantime, members should register for NHSN and review current processes in place for
informing residents and families of COVID-19 infections or related symptoms.
CDC Launches LTC Frontline Staff Training Webinar
The Centers for Disease Control and Prevention (CDC) has developed resources for frontline
staff in long term care facilities. These short webinars are all published on the Key Strategies to
Prepare for COVID-19 in Long-term Care Facilities (LTCFs) webpage at the bottom under a
“Webinar Series” section. These new webinars are intended to be a training tool/resource for
frontline long-term care staff members. CDC has also listed three “Additional Resources” to this
page, which have been updated previously.
Here are the direct links to each webinar:
• Sparkling Surfaces
• Clean Hands
• Closely Monitor Residents
• Keep COVID-19 Out!
• PPE Lessons
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And the new additional resources are
• Interim Infection Prevention and Control Recommendations for Patients with Suspected or
Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings
• Additional Guidance for Nursing Homes and Long-Term Care Settings
• Preparedness Checklist for Nursing Homes and Other Long-Term Care Settings
CDC Increases Priority for COVID-19 Testing in Long-Term Care Residents This week, the Centers for Disease Control (CDC) made changes to its priority classifications for
COVID-19 testing. The CDC has now modified its priority classifications into two categories:
high priority and priority, and both health care facility workers with symptoms and residents in
long term care facilities with symptoms are classified as high priority.
In addition, the CDC states that health care workers with contact with a person with known or
suspected COVID-19 should be considered for testing. Residents and health care workers in
long-term care facilities without symptoms may also be prioritized by state or local health
departments or clinicians, for reasons including public health monitoring, sentinel surveillance,
or screening of other asymptomatic individuals.
Previously, the CDC identified three priority levels for testing. Patients in long term care
facilities with symptoms were identified as priority two for testing while healthcare workers with
symptoms were identified as priority one and healthcare workers without symptoms as priority
three.
This update represents a positive step in continuing the push for better access to testing for both
long term care residents and staff. Providers should use this guidance when seeking testing from
hospitals, physicians, labs and local officials and advocating for faster turnaround times.
For more information, please see AHCA’s recent guidance on testing. Facilities can refer to
AHCA’s list of vendors who provide testing in nursing home setting and are FDA-approved.
OTHER NEWS
Mental Health Resources We are sharing two documents on behalf of Alliant Quality for your information. The first
document is entitled “Tips to De-Escalate Challenging Situations” and the second document is
entitled “The Well-Being of Healthcare Workers”. We encourage you to share these documents
as you see fit with your staff.
Verizon Offering Discounts to Nurses Verizon is offering discounts of $10 to $25 per month to nurses with active licenses who have
eligible Verizon phone plans. The FAQ is here.
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Launch of Updated & Expanded Version of AHCA’s Infection Preventionist
Training (IPCO) The American Health Care Association (AHCA) has released a new and expanded version of its
popular Infection Preventionist Specialized Training (IPCO Version 2) that was first launched in
2017. The program is available to members and non-members.
Phase III Requirements of Participation took effect November 28, 2019 and mandate that every
nursing facility have a designated and specially trained Infection Preventionist who is running a
comprehensive infection prevention and control program. AHCA recommends that each skilled
nursing facility train at least two Infection Preventionists through AHCA’s IPCO training
program should one Infection Preventionist leave the facility. The training is also highly
recommended for assisted living communities because they care for a similar population and
face similar infection risks.
IPCO Version 2 is designed to train Infection Preventionists and is approved for 25 ANCC
contact hours. The online course is also now approved for 22 NAB CEUs for
Administrators. AHCA/NCAL recognizes Administrators will not serve as designated Infection
Preventionists, but we recommend that Administrators consider taking the course to gain a
deeper understanding of infection prevention and control in the overall operation of a nursing
facility as this is a high target area for survey and liability.
A quick reminder that while CDC/CMS did release a free infection prevention training course in
March 2019, AHCA’s IPCO Version 2 training is far more comprehensive and includes updated
information. AHCA’s course also includes in-depth learning on topics such as water
management, antibiotic stewardship and bonus content on key issues surrounding the COVID-19
pandemic.
Alabama Nursing Home Association 4156 Carmichael Road ◆Montgomery, AL 36106◆PH: (334) 271-6214◆FAX: (334) 244-6509
Links:
Alabama Nursing Home Association http://www.anha.org
AL Board of Examiners of Nursing Home Administrators http://www.alboenha.alabama.gov
AL Dept. of Public Health http://www.alabamapublichealth.gov
CMS http://cms.gov
