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COVID-19 Updates for the Week Ending April 12, 2020

What follows are the most salient COVID-19 updates for HCA members as of the week ending April 12.

CARES Act Emergency Funds

The U.S. Department of Health and Human Services (HHS) has begun releasing emergency funds to home care, hospice and other providers as part of the recently signed federal CARES Act. (HCA shared this update in an alert to members on April 10.)

CARES includes $100 billion in relief to health care providers fighting COVID-19. An initial allotment of $30 billion is now being distributed based on a provider’s share of 2019 Medicare fee-for-service (FFS) reimbursements.

These are payments, not loans, and will not need to be repaid. Providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment within 30 days of receiving the payment using the portal at hhs.gov/providerrelief.

$200 Million in Telehealth Grants: Application Process Opens Today

Today, April 13 at noon, the Federal Communications Commission is opening the grant portal (see here) for the COVID-19 Telehealth Program, which will provide $200 million in funding as part of the CARES Act to help health care providers provide connected care services to patients at their homes or mobile locations in response to the COVID-19 pandemic.

Funding is available for: telecommunications and broadband connectivity services (such as voice services and Internet connectivity services for health care providers or their patients); remote patient monitoring platforms and services; patient reported outcome platforms; store and forward services, such as asynchronous transfer of patient images and data for interpretation by a physician; platforms and services to provide synchronous video consultation; Internet connected devices/equipment such as tablets, smart phones, or connected devices to receive connected care services at home (e.g., broadband-enabled blood pressure monitors; pulse-ox) for use by patients or health care providers; and telemedicine kiosks/carts.

DOH to Begin Surveying LHCSAs

Since late March, Certified Home Health Agencies (CHHAs) have been required to complete a COVID-19 survey. Now the state Department of Health (DOH) is implementing a survey for Licensed Home Care Services Agencies (LHCSAs) expected today. HCA will provide further updates and information to the membership.

Home Care, Hospitals Join Forces on NAHC Letter Urging Home Care Regulatory Relief

Recognizing the reciprocal stresses caused by COVID-19 — particularly in terms of decompression, surge capacity and bed availability — leading hospital associations are joining forces with home care representatives to help advocate for home care regulatory relief at the federal level.

HCA has signed onto a letter with hospital and home care association peers (led by the National Association for Home Care and Hospice) urging greater flexibility on telehealth services and billing as well as the removal of signed order constraints in home care. The letter will be delivered to U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma.

HCA Phase II Survey Results Further Outline Impacts

On April 8, HCA circulated the findings of our second survey of home and community-based providers in New York showing the impact of COVID-19 on services, staff and patients.

The results were shared in a press release garnering coverage in Home Health Care News, Modern Healthcare and the Oneonta Daily Star, along with media inquiries from the Wall Street Journal and other outlets.

HCA thanks the nearly 200 home and community-based providers who completed this second survey which provided critical information on: what agencies are doing to cope with equipment shortages; percentage changes in patient counts due to COVID-19; the number of patients refusing care for fear of exposure; what agencies are doing in cases where patients are refusing care; projected financial impacts for the foreseeable future; and more.

PPE

HCA has been tirelessly advocating for personal protective equipment (PPE) access statewide. Our advocacy has included a particular focus on New York City, where the City Health Department has resisted categorical inclusion of home care and hospice as a priority sector for PPE. Last week, the city’s Department of Health reached out to HCA seeking direct assistance and collaboration on a process for issuing some PPE to home care providers in New York City. HCA is working with potential volunteer sites within the membership to serve as points for staging and broader distribution of PPE to the New York City home care community, and we hope to announce details shortly.

New Federal Regulatory Waivers

The U.S. Centers for Medicare and Medicaid Services (CMS) announced the following new regulatory waivers or flexibilities last week (see here): occupational therapists from home health agencies can now perform initial assessments on certain homebound patients; hospice nurses will be relieved of hospice aide in-service training tasks; and hospice aide competency testing will allow use of pseudo patients.

New State Regulatory Waivers

  • In an April 10 Dear Administrator Letter (DAL), the state Department of Health (DOH) suspended some key areas of regulation, including many areas expressly requested by HCA related to employee health assessments, performance evaluations and aide training programs. (See the DAL here.) These were summarized in an April 10 alert to the membership. (See also a summary on HCA’s COVID-19 resource page.)
  • The New York State Education Department (NYSED) announced some flexibilities on the required 30 minimum clinical hours for home health aide training programs (see here). At least 8 hands-on clinical hours must occur in a home care or assisted living facility but the remaining 22 may be delivered using a remote model and “may be comprised of experiences that meet the curricular program requirements through required skill performance, project-based learning, and experiences which are all taught and supervised by the professional nurse educator.”
  • The timeframe for a home care organization to submit information into the Home Care Worker Registry is extended for 60 days. (A previous Executive Order extended the time but did not indicate for how long.) See the new update here.
  • An April 10 DOH health advisory (see here) waives the requirement that 8 hours of the 16 hours required for supervised practical training must be provided in a patient care setting.

New Guidance Documents for Managed Care, Community-Based Care

DOH last week updated its previous guidance, originally issued on March 18, for Authorization of Community Based Long-Term Services and Supports Covered by Medicaid (“COVID-19 LTSS Guidance”). See the new guidance here.

DOH has also issued a new COVID-19 Guidance for Managed Care Organization Contracting and Surveillance Relief for Managed Long Term Care Plans, Programs of All-Inclusive Care for the Elderly (PACE) and other MCOs (see here) describing some changes to the contract review and approval process as well as changes to surveillance and oversight activities.

OSHA: COVID-19 a Recordable Illness

The Occupational Safety and Health Administration (OSHA) circulated a letter (see here) stressing that COVID-19 is a recordable illness under OSHA’s record-keeping requirements and employers are responsible for recording cases of COVID-19 if the case: is confirmed as a COVID-19 illness; is work-related as defined by 29 CFR 1904.5; and involves one or more of the general recording criteria in 29 CFR 1904.7, such as medical treatment beyond first aid or days away from work.

HCA, VNSNY Lead National Webinar on NY’s COVID-19 Experience for Home Care

HCA’s Communications Director Roger Noyes joined VNSNY Executive Vice President and Chief Administrative Officer Michael Bernstein and VNSNY Vice President of Government Affairs Dan Lowenstein on a national webinar hosted by Home Health Care News on “A COVID-19 Case Study: Lessons Learned from New York’s Home-Based Care Providers.” Once available, HCA will share an archive of the webinar which drew nearly 2,000 registrants from around the nation.