Situation Report | June 15, 2020
What follows are the most salient COVID-19 updates for HCA members as of the week ending June 14, 2020.
This is a weekly digest of new information as well as briefs that may have already been provided to home and community-based organizations via e-mail alert throughout the past week.
HCA Urges Easing of DOH CHHA and Hospice Survey Frequency
HCA has recommended to the state Department of Health (DOH) that the Certified Home Health Agency (CHHA) and Hospice COVID-19 surveys be reduced from daily to once a week. This is based on the enormous amount of time agencies have to dedicate to completing the survey each day, the utility of continually repeating the same question responses, and a lack of clarity on what DOH is using the data for.
HCA has made a number of recommendations to streamline the survey, including the elimination of certain questions and the simplification of others. We also repeated our request that the previous survey data be made available to HCA, as it is critical for situational awareness to help inform our efforts on behalf of patients and their providers. The data release would also reduce the need for HCA and other associations to conduct our own, sometimes duplicative, surveys to track information from the field.
HHS Announces $15B in COVID-19 Aid to Medicaid Providers and Portal for Applications
The U.S. Department of Health and Human Services (HHS) last week announced approximately $15 billion in upcoming aid distributions intended for those Medicaid providers that have not yet received funding through the Provider Relief Fund General Distribution for coronavirus relief.
HCA is still seeking clarification as to which home care provider or organizational types (including Licensed Home Care Services Agencies and Managed Long Term Care plans) will be able to qualify, directly or indirectly, for this new Medicaid funding relief, including the eligibility of providers billing Medicaid managed care plans and/or Certified Home Health Agencies. The application documents and an HHS press release seem variously to suggest the extent of home care’s eligibility, but HCA is still seeking further confirmation in direct outreach to HHS.
Please stay tuned for further details of that confirmation.
In the meantime, providers are encouraged to review the application materials and begin preparing information.
Medicaid and Children’s Health Insurance Program (CHIP) providers eligible for these new funds will need to use an enhanced Provider Relief Fund Payment Portal to report their annual patient revenue here. Applications are due July 20. Further instructions are here.
For further background about this newly announced fund for Medicaid providers, please see the HHS page on “CARES Act Provider Relief Fund: For Providers” (under the heading “Medicaid/CHIP Provider Relief Fund Payment Forms and Guidance”).
According to HHS, “the payment to each provider will be at least 2 percent of reported gross revenue from patient care. The final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients [that] providers serve.”
As HCA has reported, the relief aid to home and community-based providers has so far involved some emergency funds, accelerated payment opportunities, and loans mostly through Medicare programs. These funds have fallen well short of the need, and Medicaid providers have largely been ineligible for relief.
Broader Advocacy for Financial Relief
Last week, HCA joined the National Association for Home Care and Hospice (NAHC) for further discussion of advocacy on needed home care prioritization in the distribution of relief funds generally.
To inform this advocacy strategy, NAHC is asking home care providers to answer a survey that will help provide data to help make the case for home care’s need. We urge HCA members to take the NAHC survey here.
HCA is separately urging an allocation of at least $200 million in funds for New York home care providers specifically. This is based on our impact estimates of COVID-19 on New York home care services and caseload losses, increased costs for personal protective equipment, and other expenses and cost exposures.
HCA has made this funding call directly to New York’s Congressional Delegation, urging such monies in the next coronavirus aid package, which is expected in July.
HCA recently launched a Legislative Action Center campaign for you and your staff to join us in this advocacy request. The process is simple: just enter your contact information and click a button here. Please ask your staff to join you in this online campaign, which has thus far netted over 2,000 messages to Congress. We need to grow this number to be as big as possible. Please act today.
New Exec Order Relaxes COVID-19 Testing Mandate for SNFs, ACFs and Home Care & Hospice Vendors
As HCA reported in a member alert on June 10, the Governor, in a new Executive Order, has decreased the required frequency of routine COVID-19 testing that staff must undergo in some of the state’s skilled nursing and adult care facilities (SNFs and ACFs).
The change only applies in regions that have reached at least a phase two of reopening. In such regions, the testing requirement is now reduced to once per week. In regions at phase one, the requirement is as follows: staff who work at a facility more than three days a week must be tested twice a week (while those who work three days or fewer per week only need to be tested once per week).
According to the state Department of Health (verbally), this requirement applies to home care and hospice providers if their staff provide services in SNFs and ACFs, as some do. Although DOH has stated that the policy’s application to home care and hospice “will be coming in writing,” a written policy has not yet been issued at the time of this report.
For home care or hospice providers who do not have SNF/ACF arrangements, the added testing requirements do not apply.
This DOH interpretation — made at the insistence of the Governor’s Office — rests on the language of a May 19 FAQ document. The interpretation runs counter to prior guidance. The interpretive conflict arose after reports that facilities had begun requiring tests of home care staff furnishing services in those settings. HCA raised concerns with this interpretation, including what appeared to be an abrupt reversal of prior policy. We continue to cite the implementation and patient service obstacles, but the Department of Health has indicated that the latest interpretation will not be reconsidered.
Legislature Leaves Town, Return Unknown
On Wednesday, the state Legislature adjourned for the second time this summer after acting on a package of criminal justice reform bills. Included in the package was the repeal of 50-a, a law that had prevented the public release of police disciplinary records. Lawmakers also took up a number of local bills and resolutions before leaving town. Many bills wait to be debated and voted on in the Senate, including legislation related to COVID-19. Governor Cuomo signed the package of criminal justice reform bills into law on Friday.
Prior to their return last week, Senate and Assembly leadership announced they would likely resume some period of session over the summer to address potential state budget cuts to education and health care, which the Governor suggested are likely without investments passed by Congress. It is unknown at this time when federal lawmakers will return to Washington; however, it’s been suggested they will take up another stimulus package in July.
Though the situation remains fluid, HCA will keep members updated on all relevant state and federal actions over the weeks to come.
June 18 Webinar on PPP Funds and New Flexibilities
HCA reported last week on the recently signed Paycheck Protection Program (PPP) Flexibility Act of 2020, which relaxes some of the loan forgiveness requirements and other components of the PPP. Your organization may be eligible for these funds and will want to learn how to leverage the new flexibilities. Experts at BKD, LLP will guide you through these intricacies during a free members-only webinar on June 18 (2:30 to 3:30 p.m.). Learn more and register here.
Two News Reports from Long Island
In an extensive interview for The Observer, a weekly newspaper in Northport, Visiting Nurse Service and Hospice of Suffolk CEO Linda Taylor describes at length her agency’s COVID-19 response work, including: new training protocols; expanded use of virtual visits, breathing devices, oxygen, Personal Protective Equipment (PPE) and other equipment by clinicians; COVID-19 case escalation and hospital referral patterns in Suffolk County; new demands on hospice services and hospice environmental modifications to ensure the safety of non-COVID-19 patients; and more.
The May 28 edition also includes a letter to the editor from Taylor describing her agency’s vital “supportive care from prevention to recovery.” She mentions some specific treatments provided in the home care setting to individuals infected by COVID-19 such as: breathing exercises, medication review that may include the addition of blood thinners, oxygen, physical therapies to improve muscle strength and overall functions, and basic educational information for patients about the virus.
This special edition of the Observer is a wealth of information that comprehensively documents one agency’s vital efforts, experiences and roles in the pandemic. You can read it in full here.
Also, HCA spoke recently to Long Island-based Newsday about the impact of COVID-19 on home care employment, noting that most provider agencies (73 percent) have seen at least a 1 to 10 percent decline in their home health aide workforce, with many agencies seeing greater impacts. “Considering that about 20 percent of positions were unfilled in January, before the pandemic, ‘there’s a need,’ said HCA spokesman Roger Noyes” and “‘Home care agencies are going to need to work more aggressively to fill unfilled positions.’”
Mid-June ‘Aware Prepare’ Newsletter and Training Links
DOH has posted a mid-June edition of its Aware Prepare newsletter featuring upcoming trainings related to preparedness, readiness, and response. In it, providers can find links to DOH’s weekly provider webinar on COVID-19 (typically scheduled every Thursday), along with a range of other topics such as: disaster-focused communications tools; Grief and Losses During the COVID-19 Crisis; Stress Management Related to Isolation, Social Distancing, and Quarantine; Integrated Health Alerting Network System Training; Community Assets Mapping; COVID-19’s Disproportionate Impact on Black Communities; and many others.
Reopening of Health Care Facilities
On October 9, the U.S. Centers for Medicare and Medicaid Services (CMS) released a guide for patients and beneficiaries as they consider their in-person care options. CMS also issued Recommendations for Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare.
This document refers only to areas in “Phase II: States and regions with no evidence of a rebound that satisfy the Gating Criteria.” It continues to recommend optimization of telehealth services to minimize the need for in-person services. “Ensuring that individuals with disabilities have tools for effective communication is a key part of optimizing telehealth services,” CMS states. Also, all individuals at higher risk for severe COVID-19 illness “should continue to shelter in place unless their conditions warrant in-person health care.”
OSHA FAQs on Face Masks
The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has published a series of frequently asked questions and answers regarding the use of masks in the workplace.
The new guidance outlines the differences between cloth face coverings, surgical masks and respirators. It further reminds employers not to use surgical masks or cloth face coverings when respirators are needed. In addition, the guidance notes the need for social distancing measures, even when workers are wearing cloth face coverings, and it recommends following the Centers for Disease Control and Prevention’s guidance on washing face coverings.
NYC Face Mask Distributions
New York City is making face coverings available for free to small businesses (those with fewer than 100 employees). Distribution partners are only able to provide five masks per employee. More information is here.
The state Office of General Services (OGS) has been made aware of a scam involving fraudulent state agency purchase orders. Agencies should be on heightened alert for receiving any purchase orders that appear out of the ordinary from state agencies or other authorized users of the state’s centralized contracts.
More information is at here.