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COVID-19 Updates for the Week Ending April 26, 2020

What follows are the most salient COVID-19 updates for HCA members as of the week ending April 26.

This is a weekly digest of new updates as well as briefs that may have already been provided to home and community-based organizations via e-mail alert throughout the past week.

To catch up on all COVID-19 updates, see the news feed on our “home care prepare” website (here), including our resource page with COVID-19 regulatory waivers, guidance and more (here).

Federal Funds and Landscape

Following a House vote last week — and earlier approval in the Senate — President Trump on Friday signed another coronavirus aid package amounting to $500 billion. It reportedly includes $60 billion in loans and grants for the Small Business Administration’s disaster relief fund, $75 billion for hospitals and $25 billion for coronavirus testing. HCA is seeking to learn more about the applicability of funds to home care providers.

As previously reported, the CARES Act allocated $50 billion for general distribution to Medicare providers impacted by COVID-19, based on 2018 net patient revenue, starting with an initial batch of payments totaling $30 billion and a second batch at $20 billion.

The first batch of $30 billion payments was itself distributed in two parts: on April 10 ($26 billion) and April 17 ($4 billion). Payments were proportionate to a provider’s share of Medicare fee-for-service reimbursements in 2019.

The remaining $20 billion is being disbursed using a different allocation method such that, when combined with the initial $30 billion, the total funds ($50 billion) are collectively proportionate to a provider’s share of 2018 net patient revenue.

On April 24, a portion of providers were expected to have automatically received advance payment from the $20 billion pool based on cost reports of revenue. Providers without adequate cost report data on file need to use a portal here. Payments will go out weekly, on a rolling basis, as information is validated.

There are some providers who will receive further, separate funding, including skilled nursing facilities, dentists, and providers that solely take Medicaid. Details on distributions have not been released, and HCA is inquiring if home health agencies will be included.

HCA members are invited to keep us informed of any issues related to the receipt of funds.

HCA is also working with our federal partners at the National Association for Home Care and Hospice (NAHC) on several payment and regulatory relief fronts in our outreach to the U.S. Centers for Medicare and Medicaid Services (CMS) and New York’s Congressional Delegation, including reimbursement increases, waivers to allow for reimbursable home telehealth in place of visits, and relief on signed physician orders, among other provisions.

CMS Suspends Advance Payment Program

CMS announced on Sunday that it is reevaluating the amounts paid under its Accelerated Payment Program. It is also suspending its Advance Payment Program to Part B suppliers. $100 billion was expended through these programs and CMS is also making its decision “in light of the $175 billion recently appropriated for health care provider relief payments,” according to a CMS press release. HCA had previously reported on these temporary loan programs.

HCA Finance Survey Extended, New Guidance on POC Changes & Your Grassroots Federal Advocacy Needed

HCA sent an alert to members on Thursday with several announcements, summarized in brief below (for further details, see our April 23 alert here).

  • We extended the deadline to complete HCA’s survey on the financial impact of COVID-19 (it’s now due April 30 at noon). The survey is here.
  • The state issued a new guidance on voluntary changes in plans of care (POCs). The guidance (see here) was addressed to managed care plans but should be read by home care providers and plans alike. It follows a letter that HCA and partner associations sent to the Governor’s office — on the issue of voluntary care plan changes — in which we also raised whether “plans and home care agencies should be given flexibility to modify the POC and reduce services when unavoidable due to COVID conditions, as long as the patient and caregivers are consulted about the change in services.”
  • HCA last week also urged members to act on an advocacy campaign led by NAHC calling for home care relief and support items. The digital advocacy campaign takes less than a minute of your time. Please follow the instructions here.

PPE

As reported last week, HCA members began receiving a shipment of personal protective equipment (PPE) from the city Department of Health and Mental Hygiene — an important step after weeks of appeals about the severe needs in home care. Under this arrangement, a limited supply has been delivered to four sites in New York City, hosted and staffed by HCA members, where home care agencies can pick up PPE based on answers to a survey. The survey sought to gauge each individual provider’s needs and prioritization based on criteria worked out with city officials. A fifth site was also being used to distribute PPE to some agencies that were not covered by the four sites.

HCA commends the sponsoring sites — Elara Caring, Selfhelp Community Services, Americare, People Care, and Parker Jewish Institute for Health Care and Rehabilitation — for providing their staff, time and other resources to this vital effort.

We expect another PPE shipment next week and will be conducting a new survey this week to determine the PPE allotments expected for May 7. New York City providers in need of PPE should be on watch for this survey. Your response to the survey is a prerequisite for obtaining a PPE allotment at one of these sites.

We recognize that the needs of providers far exceed the quantities, types of PPE, and prioritization methods thus far negotiated with city officials. But given the many contingencies of this crisis, HCA greatly appreciates this important step the city Department of Health and Mental Hygiene has taken in working with HCA, our members, and the New York State Association of Health Care Providers (HCP) to overcome the PPE supply and delivery challenges confronting home care and other settings.

Updated CMS Guidance on Infection Control and Prevention

CMS on April 23 updated its earlier guidance (originally dated March 10) for infection control and prevention (see here). The lion’s share of the updates relate to the inclusion of “religious nonmedical healthcare institutions” in the updated guidance, but the new language also answers questions on whether home health agency staff may access patients in assisted and independent living facilities. According to CMS, this is permissible, as long as state law allows it, the staff is wearing PPE, and staff “do not meet criteria for restricted access.”

The new guidance also updates some resource links and it reiterates CMS’s position on telehealth services — a position that HCA is working to move in a broader direction as we request authorization of home telehealth alternatives in home care as well as waivers to allow for Medicare billing of telehealth (see the NAHC advocacy alert above).

Associated Press Feature

Over the past few weeks, HCA has been working to provide the Associated Press with background on home care’s role in the COVID-19 response. HCA would like to specifically recognize HCA members featured in a story published on Sunday, including Americare Vice President and HCA Board Member Bridget Gallagher as well as VNSNY Executive Vice President Dan Savitt who spoke from the field level for the report entitled ‘You Are a Miracle’: Home Care Is New Front in Virus Fight. The AP report was published on many news sites, including the New York Times here.

Rural Clinics, Federally Qualified Health Centers See Easing on Nursing Visit Allowances

NAHC reported last week on a new federal guidance for rural health clinics and federally qualified health centers that eases their restrictions on visiting nurse services, noting that the waivers “have a direct impact on home health providers.”

One of the waivers allows the clinics or centers to provide visiting nurse services to homebound patients regardless of whether or not a home health agency shortage exists in the region, as is typically required. The clinics and health centers may also provide and receive reimbursement for telehealth.

Free Child Care for Essential Workers

State officials announced last week that state-designated “essential workers” (which includes home care) are eligible for child care at no cost through a partnership of the Early Care & Learning Council and Cuomo Administration. The initiative is funded through the CARES Act. HCA recommends sharing the program information with your staff here.