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COVID-19 Updates for the Week Ending June 21, 2020

What follows are the most salient COVID-19 updates for HCA members as of the week ending June 21, 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.

CHHA, Hospice Surveys Now Three Times a Week

Throughout the height of the pandemic, Certified Home Health Agencies (CHHAs), Licensed Home Care Services Agencies (LHCSAs) and Hospices have been required to conduct COVID-19 surveys daily or five days a week, depending on organization type. Beginning June 5, the LHCSA surveys were discontinued. And now, as we reported in an alert on Wednesday, the CHHA and Hospice surveys have gone from daily to three days a week: Mondays, Wednesdays and Fridays.

HCA will continue to work with the state Department of Health (DOH) on an appropriate survey frequency. We’ve called for yet-further reductions to once-per-week, along with some streamlining of questions.

Along with the survey change, DOH also advises providers to continue to submit requests for Personal Protective Equipment (PPE) to their vendors and the local Office of Emergency Management (OEM). DOH stresses that submission of PPE data to the state does not relieve providers of the obligation to continue to seek PPE from regular and local sources.

HHS Clarifies Home Care, Hospice Eligibility for Medicaid Relief Funds, Plus HHS Webcasts

As reported in an alert to HCA members on Tuesday, HCA has confirmed that home care and hospice providers are eligible for the newly announced COVID-19 relief monies intended to support Medicaid providers.

We also confirmed that entities billing Medicaid fee-for-service as well as those providing services under contract with Medicaid managed care plans are likewise eligible as long as they meet other criteria.

The deadline to apply is July 20 and applicants must use the online portal here. A total of $15 billion is available. According to HHS, applicants are eligible for payments amounting to at least 2 percent of reported gross revenue from patient care.

HHS has also announced upcoming webinars (on June 23 and June 25) for providers to learn more about the application process for the $15 billion Provider Relief Fund. You can register for the June 23 webcast here or the June 25 webcast here.

Governor Signs COVID-19 Legislation

The Governor has signed several COVID-19-related bills. Most recent among them is an expansion of the existing whistleblower protections for health care employees. The measure prohibits employer retaliation if an employee reports improper quality of patient care or improper quality of workplace safety to a news media outlet or social media forum.

Other bills do the following: commission a study on the health impacts of COVID-19 on minority communities; suspend the forfeiture of unemployment benefits during the state of emergency; and repeal a law that made it illegal to wear a face covering in a public place.

For further details on these and other bills recently signed into law, see our separate report here.

PPP Loan Program: New Application Process and HCA Members-Only Webinar Archive

The U.S. Small Business Administration (SBA) and U.S. Department of the Treasury have posted a revised Paycheck Protection Program loan forgiveness application implementing the PPP Flexibility Act of 2020. It is here.

PPP is an SBA loan program to help businesses keep their workforce employed during the COVID-19 crisis. The PPP Flexibility Act made changes to this program. Those changes were outlined in a June 18 members-only webinar with experts from BKD, LLP (an archive of the webinar is available on-demand here.)

Among the changes to PPP are an extension in the loan forgiveness covered period, a reduction in the payroll cost ratio as a threshold for loan forgiveness, exemptions to employee rehiring requirements, revisions to the loan deferral period, and a lifting of the CARES Act’s prohibition on payroll tax deferral, among other modifications.

CMS Waiver Permits Medicaid F2F Deadline Extension

On June 15, the U.S. Centers for Medicare and Medicaid Services (CMS) granted DOH an 1135 waiver for face-to-face timeframes under home health state plan services. In effect, this means the state can modify the deadline for Medicaid face-to-face encounters.

Under the waiver, the face-to-face encounter does not need to be completed before the start of services, and it may occur at the earliest time, not to exceed 12 months from the start of service.

The CMS letter is here.

HCA will be following up with the Department to urge implementation of the waiver and to determine if and when DOH expects to act on the newly granted flexibilities.

Medicare Fee-for-Service FAQs

CMS has revised its COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-service (FFS) billing. See here.

COVID-19 Testing in Home Care Q&As

Do I need a physician order for COVID-19 testing? Are testing-related procedures and services reimbursable? How do I obtain testing kits? Do I need a CLIA waiver? Must a patient be admitted to home care in order for a home care clinician to conduct COVID-19 specimen collections?

Home care and hospice providers have voiced these and other important questions that are now answered in a new Q&A document accompanying HCA’s Home Care Clinician Training for COVID-19 Testing.

Please download the Q&As and register your clinical teams for our free, on-demand training initiative. It teaches a vital skill set for meeting patient care needs and partnership opportunities in the COVID-19 health emergency.

Also: the grant supporting this initiative expires on June 30. While HCA is seeking an extension to further cover this free, on-demand training, we urge all home care and hospice providers to enroll and urge your staff to take the course as soon as possible. Just follow the steps on our website.

HCR “Bounce-Back” Committee Oversees Resurgence, Planning for Second Wave

HCA member HCR Home Care was featured in a recent article for Home Health Care News about the proactive work of its “bounce-back” committee as HCR oversees a resurgence back to pre-pandemic functions — all with a watchful eye for a second wave of COVID-19.

The article describes HCR’s engagement efforts to regain staff after an organization-wide census drop of 15 percent, HCR’s long-term strategy for meeting PPE needs, and more.

Politico New York Reports on Workforce Shortages

HCA is quoted in a Politico New York article on efforts to ease COVID-19 workforce shortages. HCA noted the “slight rebound” in workforce numbers that HCA members have reported anecdotally.

“Before the pandemic, agencies in New York state reported between 21 percent and 23 percent of their home health aide or nursing positions were unfilled due to staffing shortages. Now to overlay, on top of that, a public health emergency that results in workforce capacity decreases of 10 percent, 15 percent or 20 percent or higher, you’re trying to rebound to a position that was already understaffed,” HCA Communications Director Roger Noyes said.

OSHA Guidance Resources for COVID-19 and the Workplace

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has coronavirus-related guidance to help employers develop policies and procedures that address the following issues:

OSHA’s guidance also includes frequently asked questions on such issues as worksite testing, temperature checks and health screenings, and the need for PPE.

This guidance is in addition to the U.S. Department of Labor and HHS’ previously developed Guidance on Preparing Workplaces for COVID-19 and the White House Guidelines for Opening up America Again.

Existing OSHA standards that apply to protecting workers from infection remain in place as employers and workers return to work.

IRS Tax Guidance on Leave-Based Donation Programs

The Internal Revenue Service (IRS) has released guidance on the federal income and employment tax treatment of cash payments made by employers under leave-based donation programs to aid victims of the ongoing COVID-19 pandemic in the affected geographic areas.

Under leave-based donation programs, employees can elect to forgo vacation, sick, or personal leave in exchange for cash payments that the employer makes to charitable organizations.

The donated leave should not be treated as W-2 wages to the donating employees. But employees may not claim a charitable contribution deduction for the value of the donated leave.

The guidance is here.

New EEOC Guidance Includes Change Prohibiting Antibody Testing Mandates in Return-to-Work Policies

The Equal Employment Opportunity Commission (EEOC) has provided updated guidance to employers on their rights and obligations during the COVID-19 pandemic.

The information is here.

It covers: confidentiality of medical information; hiring and onboarding; reasonable accommodation; furloughs and layoffs; return to work; and disability-related inquiries and medical exams.

Of note, the new guidance says that employers cannot mandate a COVID-19 antibody test before allowing employees to re-enter the workplace. EEOC says this determination is based on guidance from the U.S. Centers for Disease Control and Prevention (CDC). Per CDC, EEOC determines that “an antibody test at this time does not meet the ADA’s ‘job related and consistent with business necessity’ standard for medical examinations or inquiries for current employees.”

For its part, the CDC states that “serologic test results should not be used to make decisions about returning persons to the workplace.” EEOC said it will monitor CDC guidance for any further adjustments as necessary.

EEOC does remind employers that an antibody test is different from a test to determine if someone has an active case of COVID-19 (i.e., a viral test). “The EEOC has already stated that COVID-19 viral tests may be permissible under the ADA,” notes an accompanying press release.

HCA is checking to learn more about the applicability of this guidance requirement for health care workers.

U.S. DOL Webinars on Regulations

The U.S. Department of Labor (DOL) will host four webinars in June and July to discuss how it is reducing regulatory burdens and making it easier to understand and comply with the law. The webinars will also provide an opportunity for workers, employers, and state and local governments to ask questions and discuss how the Department can expand and improve access to its compliance assistance materials.

The webinar for Health Care and Emergency Responders is on July 1, 2020 from 1 to 2:15 p.m.

Registration is at https://tinyurl.com/yctj84tr.

Children’s Waiver Services

CMS has approved a 1915c Children Waiver Appendix K Amendment for COVID-19, according to the state Department of Health, who posted an announcement here.