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COVID-19 Updates for the Week Ending June 7, 2020

What follows are the most salient COVID-19 updates for HCA members as of the week ending June 7, 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.

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

Act Now to Grow Home Care’s Impact for COVID-19 Aid

In response to two alerts issued over the past two weeks, New York home care organizations have sent nearly 1,600 messages to Congress urging COVID-19 financial relief for home care using HCA’s Legislative Action Center. Please help us grow this impact. Write today and enlist dozens of colleagues at your organization to write Congress along with you.

The process is simple. Click the link here to act now. Then share the link, along with instructions, to your colleagues and staff asking them to join you in HCA’s online advocacy campaign. You can help grow our impact.

As HCA has reported, another coronavirus aid package is expected in July. Senate Majority Leader Mitch McConnell has signaled that this may be the final aid bill. Now is the time for home care to be vocal, especially when all other sectors are likewise calling for aid.

Home care is at the frontlines of the COVID-19 response. It likewise needs primary recognition in the next aid package at a time when New York providers are facing a projected $200 million in losses. Act now today. 

PPP Flexibility Law Revises Terms for Loan Forgiveness

President Trump on June 5 signed into law a bill intended to provide additional flexibility for businesses receiving loans under the Paycheck Protection Program (PPP), a Small Business Administration loan program under the CARES Act to help businesses keep their workforce employed during the COVID-19 crisis.

The PPP established certain thresholds for businesses to meet in order to receive loan forgiveness. Under the new changes, businesses are eligible for loan forgiveness if they spend the funds within 24 weeks (up from the previous threshold of eight weeks). Sixty-percent of funds must be used for payroll expenses in order to receive loan forgiveness. The previous threshold was higher: at 75 percent.

Borrowers who applied for PPP forgiveness are also eligible to delay the payment of payroll taxes under the new law.

According to news reports, approximately $120 billion in PPP funds remain.

LHCSA COVID-19 Survey Ends; CHHA and Hospice Surveys Still Required

As HCA informed members in an alert on Friday (June 5), the state Department of Health (DOH) is no longer requiring Licensed Home Care Services Agencies (LHCSAs) to submit the LHCSA COVID-19 Survey that has been in effect five days per week since mid-April.

HCA has confirmed that the daily Certified Home Health Agency (CHHA) and hospice surveys still need to be submitted. HCA recommended that those surveys either be eliminated or their frequency be reduced. It is our understanding that this request is being considered.

Questions should be directed to covidhomecareinfo@health.ny.gov

HCA has appealed for DOH to share data on all of these surveys. This data is critical for situational awareness in support of the industry. The sharing of data would also reduce the need for HCA and other associations to conduct their own, sometimes overlapping, surveys in our efforts to track information from the field.

The state has shared some data, including a snapshot of home care census and COVID-19 case counts. HCA will work with the Department to seek even more, granular data. 

DOH Guidance for Resumption of Aide Training Programs 

In an alert to members on June 2, HCA shared a DOH guidance requiring aide training programs to develop policies and procedures prior to the resumption of trainings. 

Agencies must take into consideration social distancing guidelines, develop a process for screening trainees prior to entering classroom or lab settings, ensure the availability of personal protective equipment (PPE), and determine how to meet the 16-hour supervised practical training requirement conducted in the skills lab setting.  

HCA has been advocating for provider relief related to aide training programs (initial and in-service) during the COVID-19 pandemic. To help inform these efforts, please tell us how this guidance will affect your operation of training programs. Write to Andrew Koski at akoski@hcanys.org 

Reminder: Webinar on Home Care, Hospice Training for COVID-19 Testing 

Home care and hospice professionals are already enrolling in “Home Care Clinician Training for COVID-19 Testing.” 

What about nurses and respiratory therapists at your organization? 

On May 28, HCA held a launch webinar to provide background about the role of home care and hospice professionals in COVID-19 testing. The webinar also walked through the process for home health agencies and hospices to enroll in our complimentary on-demand training program.  

If you missed the webinar, you can view an archive here or sign up directly for our training program here.  

We encourage all home care and hospice organizations in New York State to take advantage of this training with the costs fully covered by HCA under a grant HCA secured from the Mother Cabrini Health Foundation. Your participation will create the infrastructure necessary and ready to act in the home care setting. Indeed, the state and federal governments look to you — and the health care system broadly — for a continuing build-up of COVID-19 specimen collection and testing capabilities. 

Updated DOH Guidance on Testing Criteria and Prioritization   

On May 31, DOH issued an “Updated Interim Guidance on the Protocol for COVID-19 Testing Applicable to All Health Care Providers and Local Health Departments.” It revises an earlier guidance issued on April 26.

A side-by-side comparison reveals what appear to be expanded circumstances under which diagnostic and/or serologic testing shall be authorized.

The guidance recognizes symptoms of Multisystem Inflammatory Syndrome in Children (MIS-C) as a criteria for testing, along with testing prior to a medical procedure (including elective procedures) and more detailed circumstances for testing of health care workers and individuals employed by essential businesses or by any businesses designated to reopen.

It states that “diagnostic and/or serological testing for COVID-19 shall be authorized by a health care provider when an individual is employed as a health care worker, first responder, employee of a nursing home, long-term care facility, or other congregate care facility, or other essential employee who directly interacts with the public while working.”

The guidance likewise delineates new and expanded circumstances for prioritization when ordering a COVID-19 test.

HCA will be checking with DOH to confirm the effects, if any, of this guidance on home health and hospice staff.

CMS Releases Revised Guidance Setting Path for More Routine Surveys

CMS has updated its instructions to state survey agencies on prioritization of survey activities.

In March, CMS re-prioritized and suspended certain survey activities, with a focus on Immediate Jeopardy, Focused Infection Control, and Initial Certification surveys. 

The newly updated instructions, issued on June 1, focus on nursing home surveys but they also note how all other providers would be transitioned back to the resumption of more routine survey actions beyond the focus areas described above.

In the June 1 memo, CMS says that states are authorized to expand beyond the current survey prioritization “in order to transition states to more routine oversight and survey activities” once a state has entered phase 3 of the “Nursing Homes Re-opening guidance, or earlier, at the state’s discretion.”

States are instructed to prioritize providers based on a history of noncompliance, or allegations of noncompliance, with the below items:

  • Abuse or neglect
  • Infection control 
  • Violations of transfer or discharge requirements 
  • Insufficient staffing or competency
  • Other quality-of-care issues (e.g., falls, pressure ulcers, etc.) 

CMS also says that accrediting organizations may resume normal survey activities based on state reopening criteria. Any variations from the approved reaccreditation survey process must receive CMS approval prior to implementation. 

NYC to Hold June 10 Webinar on PPE Purchasing Capacity Building

The New York City Department of Health and Mental Hygiene (NYC DOHMH) will be holding a webinar on June 10 from 2 to 3 p.m. about “PPE Purchasing Capacity Building for Providers.” Registration is here. This webinar will provide a refresher on guidance for the use of PPE, inform agencies how to calculate a PPE burn rate, and share considerations and best practices for purchasing PPE. 

The webinar is geared for agencies with limited to no experience purchasing PPE who have health care workers on staff that require PPE for interactions with clients, patients or residents. Information on PPE suppliers will also be provided. 

Information on PPE and medical supply companies is available here.  

For the last two months, NYC DOHMH has made available PPE for distribution to home care providers. HCA members (Americare, Selfhelp Community Services, Elara Caring, People Care and Parker Jewish Institute for Health Care and Rehabilitation) have utilized their time and resources to act as distribution sites through this effort, coordinated by HCA, the New York State Association of Health Care Providers and NYC DOHMH.

CMS Issues Guidance on Safely Delivering Beneficiary Notices in COVID-19

In a Medicare Learning Network article, the U.S. Centers for Medicare and Medicaid Services (CMS) provides guidance on safely delivering beneficiary notices amid COVID-19. In light of concerns related to COVID-19, current notice delivery instructions provide flexibilities for delivering notices to beneficiaries in isolation, including when treating a patient with suspected or confirmed COVID-19.

The notice explains circumstances for when hard copies may be dropped off with beneficiaries in a hospital room. (Notices may be e-mailed “if a beneficiary has access” to e-mail “in the isolation room” and the “notices should be annotated with the circumstances of the delivery.”)

Notice delivery may be made via telephone or secure e-mail to beneficiary representatives who are offsite. The notices should be annotated with the circumstances of the delivery, including the person delivering the notice via telephone, and the time of the call, or when and to where the e-mail was sent.

Copies of the various forms and instructions for their use are at here.

CMS encourages the provider community to review all of the specifics of notice delivery, as set forth in Chapter 30 of the Medicare Claims Processing Manual here.

FDA Issues Emergency Use Authorization on PPE

On May 22, the U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) in response to concerns about insufficient supply and availability of PPE. Under EUAs, the FDA may allow unapproved medical products or unapproved uses of approved medical products to be used in an emergency when there are no adequate, approved, and available alternatives.

The May 22 EUA lists over half a dozen supplies that can be used as PPE in the absence of alternatives for low or minimal risk level situations:  

  • Conductive shoes and shoe covers
  • Operating room shoes
  • Surgical apparel accessories
  • Nonsurgical isolation gowns
  • Operating room shoe covers
  • Surgical helmets
  • Surgical caps

Workers’ Comp Emergency Regs for Testing and Q&A

The Workers’ Compensation Board adopted emergency regulations allowing reimbursement for COVID-19 testing when there is a claim for workers’ compensation due to workplace exposure to COVID-19. The regulations are here

In addition, the Board has published a Q&A document to answer questions about workers’ compensation benefits to employees who get COVID-19 while on the job. The Q&A is available here.  

Employers are reminded that they must contact their workers’ compensation insurance carrier immediately if a worker reports that he or she is sick due to a workplace exposure. The insurance carrier then has 18 days to act on the claim and must begin paying benefits within this timeframe if the claim is accepted.

CDC Guidance on Washing Cloth Face Coverings

The U.S. Centers for Disease Control and Prevention (CDC) has released revised guidance for washing cloth face coverings here.

The CDC has also posted a document called “Use Personal Protective Equipment (PPE) When Caring for Patients with Confirmed or Suspected COVID-19” here.

See here for the CDC’s guidance on cleaning and disinfecting.