COVID-19 Update

August 11, 2020

Thought of the Day

There is no such thing as failure, there's just giving up too soon. Jonas Salk (Virologist, Medical researcher)

Virginia

Tomorrow’s Call: Nursing Home Antigen Testing Guidance/COVIDWISE App – (8/12-11 am) On tomorrow’s member call, Shaina Bernard (VDH) will provide an overview of the Virginia Department of Health’s new Interim Point-of-Care Antigen Testing Recommendations for Nursing Homes.

The call information is below. Point-of-Care antigen testing key points include:

• 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

Jeff Stover (VDH) will also provide a brief overview of the COVIDWISE app.

Nursing Home and Hospice COVID 19 Supplemental Payments Summary 8/7/2020 Transactions (8/14/2020 Payment) Below is a summary regarding the data submitted by nursing homes for the COVID19 temporary supplemental payment increase of $20 per patient day. This summary includes all nursing home data submitted between July 14, 2020 and July 31, 2020 for dates of service from March 12 to June 30 that has not previously been processed for payment. The $20 per diem COVID payments will be incorporated into rate setting for dates of service from July onward. Reconciliation for March-June 2020 service dates have not yet been scheduled at this time.

• A total of 28 unique nursing home NPIs were submitted. Of these 28 nursing home NPIs: - Twenty-eight nursing home NPIs were included for payment - Eleven submitted hospice patients - Six submitted PACE patients Summarized payment and reported patient days are below:

Reminder: Virginia Long Term Care Hurricane Preparedness in a COVID-19 Environment Webinar The Virginia Healthcare Emergency Management Program, in cooperation with the Virginia Department of Health’s Office of Emergency Preparedness and the Virginia Hospital & Healthcare Association, will discuss Virginia’s Long Term Care Mutual Aid Plan and preparing for hurricane season during the COVID- 19 pandemic, including sheltering in place, evacuations, and medical surge. (August 12 | 2-3 pm) Register

Reminder: Nursing Home NHSN Reporting As of Monday, August 3, 180 nursing homes have conferred rights to VDH in National Healthcare Safety Network (NHSN). According to the Virginia Department of Health, 285 (out of 287) Virginia SNFs are currently reporting COVID-19 data to NHSN. VDH requested that we remind members to share their NHSN data with VDH - click here for instructions. Licensed but not certified nursing homes are not required to report data to CMS, but they may report to NHSN and are encouraged to confer rights to VDH. Reporting through NHSN is one of many criteria for a nursing home to enter Reopening Phase I. Please refer to the June 5 memo for additional information. Per the Code of Virginia (§32.1-35.1), data required to be reported to the NHSN to meet CMS requirements should be shared with VDH through the NHSN system. In order for VDH to view data from Long-Term Care Facilities reporting in NHSN, each facility has to join the VDH NHSN group.

VDH Provides Additional Respiratory Fit Testing Train-the-Trainer Sessions Throughout the State The Virginia Department of Health is providing additional regional Respiratory Fit Testing Train-the-Trainer courses. The course purpose is to ensure that each health district and medical practice have qualified staff to provide respirator fit testing. In addition, the attendee can train others in the proper procedures for fit testing. This training is for qualitative testing using a hood and not quantitative testing. Everyone that attends the free course needs to have:

1. Completed the OSHA Medical Questionnaire form 2. Secure physicians or other licensed healthcare professional’s signature on the Medical Recommendation form. 3. Bring your N95 Fit Test Kit and N95 Respirator to training – See an example

Click here to register (Course ID 1046592) - Training Dates and locations include:

August 13, 2020 - Dinwiddie Community Enhancement Center (Petersburg) August 17, 2020 - Eastern Shore Regional Fire Training Center August 18, 2020 - Norfolk Health Department August 20, 2020 - Virginia State Police Training Academy (Richmond) August 25, 2020 - Harrisonburg Rescue Squad August 26, 2020 - Department of Social Services (Fairfax) September 1, 2020 - Virginia Highlands Community College (Abingdon) September 2, 2020 - Roanoke Valley Regional Fire-EMS Training Center

VDH wants to hire around 100 workers to enforce COVID-19 guidelines Having received upward of 23,500 complaints about businesses failing to comply with Gov. Ralph Northam’s coronavirus regulations, the Virginia Department of Health wants 100 temporary workers to help respond. The agency is submitting a $6 million request to Northam’s administration for the positions and travel and equipment costs, said Julie Henderson, director of VDH’s Office of Environmental Health Services. Read the RTD Article

Long Term Care VHASS Daily Situation Report (Click here to view public dashboard)

• Licensed Nursing Facilities reported 522 confirmed COVID-19 residents. • Facilities reported 712 residents pending COVID-19 test results. • Licensed Nursing Facilities reported a total of 3,191 confirmed COVID-19 residents recovered (cumulative). • PPE: Four facility reported difficulty obtaining PPE in the next 72 hours - 0 facilities need face shields - 3 facilities need N95 masks - 1 facilities need gloves - 0 facility need isolation gowns - 0 facilities need surgical masks • 46 of 286 facilities did not update VHASS in 72+ hours (84% response rate).

You Asked, We Answered!

Adult Day

Revised VDH Covid-19 Guidance for Day Programs The Virginia Department of Health (VDH) updated its COVID-19 Interim guidance for Group/Congregate Day Program Settings. These programs include adult day programs and any other place where groups congregate for extended periods but do not reside. More

Adult Day Transportation Question: Access2 Care is the new transportation vendor that Medicaid has contracted with in place of Southeast trans for Anthem - do you have contact information when they are not able to find a provider to transport?

DMAS Response: They currently have the contract with Anthem to transport Medicaid members for DMAS. If you have transportation concerns, we encourage you to reach out to Access2Care, first, by calling their Ride Assist line at (855) 325-7581 Option 1. If you are not able to receive a resolution, then please feel free to contact DMAS' Transportation Unit at [email protected] ---- Point of Care Testing Question: Can we bill for point of care testing?

Answer: CMS stated in the MLN Matters article that Medicare and Medicare Advantage plans would pay for diagnostic lab testing of residents. Antigen tests are diagnostic, so then the question becomes does point-of-care qualify as “lab?” When explaining in the FAQs about lab reporting requirements, CMS used language that seemed to indicate a lab included point-of-care testing sites such as the nursing home. Additionally, we know that nursing homes must have the lab (CLIA) certificate or waiver and must adhere to lab reporting. So it would seem that these point of care antigen tests would count as diagnostic lab tests, but we’ve not seen the question asked and answered explicitly. ---- Surveyor Testing Question: Are surveyors being tested for COVID-19 and how frequently?

OLC Response: Surveyors are not being tested at this time - testing is not required by CMS or VDH ---- Surveyor Restrictions Question: Are there restrictions/parameters for surveyors to go from a building with known positive cases to one that has no positive cases?

OLC Response: Surveyors wear full PPE while in the facilities. Their time in the facilities is limited with no direct resident contact. The surveyors perform daily self-screening and also participate in screening upon entering facilities. The surveyors have PPE with them and dispose/change PPE when going from one building to another.

Question: Are surveyors being required to wear specific PPE when they survey SNFs, or does that vary with the county case rate/positive status or other specific criteria in each location?

OLC Response: The surveyors have been issued full PPE which consists of fit-tested N95 masks, face shields, head coverings, gowns, gloves and shoe covers. The surveyors wear full PPE in every facility, regardless of the case rate or positive status of the facility or surrounding location. ---- Nursing Home Reopening FAQs The Virginia Department of Health Nursing Home Reopening FAQs address:

• Testing • PPE • Infection Prevention and Control, • Resident Placement/Cohorting • Phase Progression and Regression

LeadingAge Virginia in the News!

Virginia’s Nursing Homes Prepare for Sweeping New Testing Requirement In a July 29 letter to Dr. Brett Giroir, the U.S. assistant secretary for health, LeadingAge — a national association of nonprofit aging services providers, including nursing homes — pointed out that antigen tests have a 20 percent false negative rate. That’s led other federal agencies to recommend a follow-up PCR test in the case of a negative result. Dana Parsons, vice president and legislative counsel for LeadingAge Virginia, said facilities are still waiting for finalized guidance from the Virginia Department of Health on how antigen testing should be used in a nursing home setting. Read the Virginia Mercury Article

Special Education around COVID-19 Complimentary Webinars & Calls

CEU LeadingAge Virginia Education Opportunities The full list of educational offerings can be found here.

LeadingAge National Daily Online Updates – Moving to Twice a Week LeadingAge daily calls will move to Mondays at Wednesdays at 3:30 pm beginning in August. Register now.

Weekly COVID-19 Calls with Affordable Housing Every Wednesday | 9:00am to 10:00am (offered by LeadingAge Maryland and LeadingAge Ohio) Click here to access For audio only, call:1 (646) 749-3122 | Access code: 389-687-645

CMS COVID-19 Stakeholder Engagement Calls – July 27th to August 14th CMS hosts varied recurring stakeholder engagement sessions to share information related to the agency’s response to COVID-19. These sessions are open to members of the healthcare community and are intended to provide updates, share best practices among peers, and offer attendees an opportunity to ask questions of CMS and other subject matter experts. Call details are below. Conference lines are limited so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and professional networks. These calls are not intended for the press. Calls recordings and transcripts are posted on the CMS podcast page.

Weekly COVID-19 Care Site-Specific Calls CMS hosts weekly calls for certain types of organizations to provide targeted updates on the agency’s latest COVID-19 guidance. One to two leaders in the field also share best practices with their peers. There is an opportunity to ask questions of presenters if time allows.

• Nursing Homes (twice a month on Wednesday at 4:30 PM Eastern) Wednesday, August 12th | 4:30 – 5:00 PM Eastern Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 7857618; Audio Webcast Link. • Nurses (twice a month on Thursdays at 3:00 PM Eastern) Thursday, August 13th | 3:00 – 3:30 PM Eastern Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 7844289; Audio Webcast Link.

Lessons from the Front Lines: COVID-19 (twice a month on Fridays at 12:30 – 2:00 PM) Lessons from the Front Lines calls are a joint effort between CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians are invited to share their experience, ideas, strategies, and insights with one another related to their COVID-19 response. There is an opportunity to ask questions of presenters. This week’s Lessons from the Front Lines:

• Friday, August 7th | 12:30 – 2:00 PM Toll Free Attendee Dial-In: 833-614-0820; Access Passcode: 4695240; Audio Webcast Link.

Weekly LeadingAge Virginia Member Call Wednesday, August 12 | 11 am Please join us for an open conversation call on Wednesday, August 12 at 11:00 am to discuss the real struggles communities are facing such as staffing challenges and how to minimize the risk to residents and staff during this trying time. We ask that you please use this link to access the call and power point. If you are only able to join by phone, please call the number below and use your muting options. Dial: +1 (312) 757-3121 Access Code: 131-252-125

Reimagining Your Workforce Webinar Series from Gold Elite Sponsor CLA Wednesday August 12 and September 9 The COVID-19 crisis has shown that our resilience and determination can get us through the most difficult situations. Organizations around the world are facing unexpected challenges as we navigate new workplace procedures, including the health and safety of our people. As we return to work and reinvent our workplace, staying up-to-date on the latest information will help us succeed. Attend the webinar series to learn how to attract, retain, engage, and grow a productive and healthy workforce - Register here. Upcoming sessions include:

• Review, Adjust and Grow - August 12 • Create Workforce Opportunities - September 9

NEW Webinar: Implications For and Impact on Careers Join The Global Ageing Network, the Heritage Foundation, and BDU Heritage Center for Gerontology on August 18 for a webinar on COVID-19’s impact on caregivers. The webinar, moderated by Rosy Pereyra, MD, will include a 60-minute session via ZOOM, 3 panelists, and a Q and A. Panel members include: Robert Espinoza, PHI, New York City Robyn Stone, LeadingAge LTSS Center @UMass Boston Costis Prouskas, Hellenic Association of Gerontology and Geriatrics, Greece. To register, contact Shannon Davis.

HQIN QAPI: Everyone Has a Role and a Responsibility Webinar Tuesday, August 25 | 2:00 p.m. ET/1:00 p.m. It takes a team to ensure improvement is made and sustained. During this session, HQIN will discuss how to engage your team in the quality improvement process in order to hardwire systems, change behavior, reduce gaps and improve care and compliance. Click here to register.

National

LeadingAge Asks: Insurers Paying for Employee Testing LeadingAge has learned that some health insurance plans are now refusing to pay for staff testing, citing a Department of Labor memo related to noncoverage of surveillance testing (testing based not on symptoms or exposure, rather across a group of employees). LeadingAge is seeking input from other members that may have had similar experiences, with insurers refusing to pay for requisite testing. If you’ve had an insurer refuse payment, email Janine Finck-Boyle.

Affordable Housing

HUD Announces October Restart of Physical Inspections On August 7th, HUD announced that the agency will resume REAL Estate Assessment Center (REAC) inspections of HUD multifamily and public housing properties in early October. HUD halted physical inspections on March 13th due to health concerns; the agency said it will utilize strict safety protocols to restart operations. According to HUD’s press release, standard 14-day physical inspection notifications to owners will resume no earlier than September 21st, 2020, with the first inspections resuming on or about Monday, October 5th.

Property Inspection Prioritization COVID-19 Risk: REAC developed a “heat map” that categorizes states and localities into four categories of risk, from low to high, based on the latest COVID-19 rates. To keep the residents and staff of HUD properties safe during the inspection process, REAC will prioritize inspections based on COVID-19 data from Johns Hopkins University and health scoring methodology from the Harvard Global Health Institute. State Health Risk Score (1-Lowest to 4-Highest):

• Green - Low (Less than 1 daily new case per 100k people, 7-day average) • Yellow - Moderately Low (Between 1 and 10 daily new cases per 100k people, 7-day average) • Orange - Moderately High (Between 10 and 25 daily new cases per 100k people, 7-day average) • Red - High (25 or more daily new cases per 100k people, 7-day average)

Inspections will be prioritized for localities rated “green,” or low risk. The risk map is available from HUD here; the clickable map shows detailed, county-level risk levels. HUD has said the risk map will be updated over time. Property Condition: In addition to an area’s exposure risk, properties will be prioritized for inspections based on previous scores, with historically low REAC scores in low risk localities first. In a presentation provided by REAC staff to LeadingAge in June 2020, HUD stated that senior housing communities would be deprioritized from the initial return to inspection operations.

LeadingAge Priorities for Safe Physical Inspections In July, LeadingAge submitted to the agency priorities for HUD’s Return to Physical Inspection Operations. Driven by member feedback, the priorities included prioritizing the health and safety of residents, staff and inspectors during any restarting of physical inspections, and to exclude senior housing communities during the ongoing health emergency. LeadingAge priorities also include absolving owners from fault or consequence if an inspection is cancelled due to COVID-19.

NSPIRE Demonstration Program Inspections under HUD’s two-year demonstration program were also halted in March. HUD staff have told LeadingAge that NSPIRE inspections will continue on the same schedule as standard REAC inspections. For updates about the NSPIRE demonstration program during COVID-19, and to answer questions about the recently-updated NSPIRE inspection standards, LeadingAge will host HUD staff on its August 17th Housing Advisory Group call (members received a calendar invitation for this call). For more information, email [email protected]

LeadingAge Housing Recap: This week’s recap of LeadingAge housing updates is available here.

Home Health and Hospice

COVID-19 Social Connectedness Supplemental Funding Bill Introduced in the Senate Senator Tina Smith (D-MN) introduced S. 4477, the “Strengthening Social Connections Act of 2020.” This bill would provide emergency supplemental funding to programs that strengthen social connectedness and address the negative health effects of social isolation in the Older Americans Act (OAA). Senator Smith was a critical leader in authorizing legislation that was ultimately included in the reauthorization of the OAA to support older Americans who are socially isolated. The Senator is advocating for the inclusion S. 4477 in the COVID-19 relief package that is under development. S. 4477 would appropriate:

• $80 million for the HCBS supportive services for older adults, with a focus on activities to prevent and mitigate the negative health effects of social isolation, which may include activities addressing the investments in the purchase of technology. • $18 million to enhance outreach to older adults and provide technical assistance to help aging services providers, nutrition providers and community groups, and Area Agencies on Aging, reduce the negative health effects of social isolation and loneliness among older adults. • $6 million to address the health effects of social isolation on minority aging populations.

Nursing Homes

New Provider Relief Fund Update HHS issued further guidance on the $5 billion in Provider Relief Funds that were announced in July. According to the announcement the $5 billion distribution will provide:

• $2.5 billion in upfront funding to support increased testing, staffing, and PPE needs. • $2 billion in funds linked to performance – specifically the prevalence of COVID in the nursing home’s county/community compared to the prevalence in the nursing home. • Additional funds related to quality improvement efforts and isolation units.

HHS expects to begin dispersing the funds in mid-August, with performance-based distributions throughout the fall. Presumably the previously announced condition will still apply, that nursing homes take an on line infection prevention course provided by/through HHS. More details to come.

More Providers Eligible to Apply for Relief Funds The U.S. Department of Health and Human Services opened its Provider Relief Fund application portal Monday, August 10 to some new Medicare providers and re-opened it for others who may have missed a prior chance to apply according to its announcement. These providers will have until August 28 to submit their application. More

CMS Releases SNF PPS FY 2021 Final Rule The SNF PPS FY 2021 final rule was announced July 31 and published in the federal register on August 5. The new rule will go into effect with the beginning of the fiscal year on October 1 and includes a 2.2% increase. LeadingAge submitted comments on the proposed rule and a summary of the final rule, including our comments, follows below. More

Meeting with Admiral Giroir on antigen testing machines. LeadingAge recently met with HHS Assistant Secretary for Health and White House testing coordinator Admiral Brett Giroir about antigen testing and the machines that will be sent to all nursing homes in the country. Admiral Giroir noted that the ideal would be to provide low cost, 100% accurate PCR tests for all residents and staff. Recognizing that this is not possible with current shortages and test delays, HHS wanted to do the best thing possible for nursing homes, hence the Quidel and BD machines. He addressed several other points and answered questions. Further he offered to appear on a member call and said he would invite Seema Verma to join him. Following is additional information that Admiral Giroir provided:

• Concierge for test kits: Nursing homes are prioritized for antigen test kits; they will use a special concierge system. • State antigen testing policy: He talked to health directors in several states and expects they will be amenable to changing their policies concerning not accepting antigen test results from nursing homes. • False negatives and double testing: He cited research showing that the rate of false negatives is not 82/84%. The tests are closer to 95% accurate and FDA will change their labeling consistent with this research. Negative test results do not need to be repeated with a PCR test unless the person is highly symptomatic. • Additional information coming: As we already know, there will be additional information from CMS soon.

Updates to NHSN COVID-19 Module CDC updated the testing data elements on the NHSN COVID-19 reporting module. These data elements are contained within the “Resident Impact and Facility Capacity” pathway. Previously, the data elements simply asked about access to testing. The data elements have now been updated to specify types of tests (nucleic acid and antigen) and ask about barriers to testing. The data elements also now ask about turn- around time for test results, whether or not facility-wide testing has been conducted over the past 2 weeks, and if so, why testing was conducted (symptom onset, in response to an outbreak, as part of surveillance, etc.). CDC indicated that this information will help improve understanding of barriers to testing. LeadingAge also note that the PPE module was updated over the past few weeks to clarify that when responding to data elements about PPE supply, providers should consider conventional capacity. If providers have only contingency or crisis capacity supplies, they should be responding “no” to indicate that they do not have any supply of the selected PPE.

NHSN will be hosting another data quality webinar this Wednesday, August 12 at 1:00pm ET, where these changes will likely be reviewed. Space is limited and registration is available on the NHSN COVID-19 LTCF module site.

Member Resources

LeadingAge Virginia Weekly Member Call Recording – 8.5.2020

Guidance: Reopening in Virginia - Member Perspective and Resources Please check out the LeadingAge Virginia Covid-19 Resource page for resources and member policies.

New Resources from LeadingAge

• Senior Housing Weekly: Recap of LeadingAge Updates • Nursing Home Weekly: Recap of LeadingAge Updates • New Q & A Resource on Point of Care Testing • HUD Announces October Restart of Physical Inspections • More Providers Eligible to Apply for Relief Funds • This video tutorial provides strategies for clearer communication while wearing a mask, especially when caring for people living with dementia. • White Paper from Member, SeniorOptions: Renewal Strategies Interrupt the Effects of Stress and Strain

Lessons from the Pandemic on Addressing Loneliness In this 20-minute QuickCast, Jennifer Molinsky highlights lessons learned in addressing loneliness among older adults—and the challenges related to the equitable deployment of strategies.

Intergenerational Programs and Physical Distancing Guide Generations United developed a guide to share ideas and solutions on how intergenerational professionals can adapt programs and activities and create new intergenerational connections during the COVID-19 pandemic.

Advance Care Planning and Serious Illness Communication In the face of COVID-19, advance care planning is more important than ever. We’ve gathered materials and resources to help you have conversations with residents and clients who are high risk for serious complications of COVID-19. Visit the Advance Care and Serious Illness Resources page for trusted resources offering tools, tips, advice, and best practices. New CAST Case Study: Communicate Without Removing PPE As the pandemic changes how healthcare professionals operate, the Vocera Badge helps providers communicate hands-free, without needing to remove personal protective equipment. A new CAST case study, “Increasing Staff Efficiencies During COVID-19 Through Communications Technology,” shares how team members at Hardin Memorial Health used this technology as part of their COVID-19 response.

State Data & Policy Actions to Address Covid-19 Kaiser Family Foundation last week released a paper that provides state-level info on social distancing measures, health policy actions, testing and provider capacity. Key data points:

• Data reporting status: 47 states are reporting COVID-19 data in long-term care settings • Long term care settings with known cases: 13,411 across 44 states • Number of cases in long-term care settings: 322,505 across 43 states • Number of deaths in long-term care settings: 59,506 in 42 states • Long-term care setting cases as a share of total state cases: 10% across 43 states • Long-term care setting deaths as a share of total state deaths: 44% across 42 states

COVID-19 Documentation: Actions Communities Should Take Now In this NEW 18-minute QuickCast, Sean Fahey identifies several key documentation areas providers should address to minimize risk in the future.

LeadingAge Virginia TV 12 hours of resident engagement programming streamed to your community at no charge. Click here to learn more and sign up (you must be logged-in with your LeadingAge Virginia username and password). Program schedules are updated every Tuesday and Friday. Click here for the program schedule for August 12 - 14. Contact Sydney Thomas at [email protected] to receive future schedules by e-mail.

Important COVID-19 Contact Information

• Auxiliary Grant: [email protected] • Businesses - COVID-19 Questions: [email protected] • CCC Plus: [email protected] • CMS: [email protected] • DMAS: [email protected] • DMAS Transportation Unit: [email protected] • LeadingAge National: [email protected] • MDS Questions: [email protected] or [email protected] • Price Gouging Complaints: Virginia Office of the Attorney General • Regional HealthCare Coalitions • VHASS

Ongoing Member Support If you receive a positive diagnosis in your community, staff or resident, after calling the Department of Health, reach out to Melissa Andrews on her cell at (202) 360-1296 or [email protected].

As always, if you have any regulatory issues or need technical assistance, reach out to Dana Parsons at [email protected].

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