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.