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COVID-19 Updates for the Week Ending May 25, 2020

What follows are the most salient COVID-19 updates for HCA members as of the week ending May 25.

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).

Case Counts & Testing 

In daily briefings throughout the past week, Governor Cuomo pointed to continuing declines in COVID-19 hospitalization rates as well as drops in identified cases.

He also pointed to an increase in testing capacity, with a goal of testing every person in New York State.

The state has begun sending 320,000 testing kits directly to nursing homes. The distributions come at a time of heightened scrutiny, calls for legislative hearings and ongoing questions about prior state policy decisions pertaining to discharge of COVID-19 patients from hospitals to skilled nursing facilities as well as the ability of nursing homes to meet new testing mandates.

Reopening

The Capital Region last week joined a list of five other areas that are now eligible for the first phase of a staged “reopening” based on criteria related to hospitalization and infection rates as well as thresholds on testing and regional employment of contract tracers.

In another “reopening” development, the Governor also announced a pilot program to allow some outside visitors in 16 hospitals across New York State. He also announced that Nassau and Rockland County hospitals can now resume elective procedures, joining facilities in other locations already authorized to do so.

State Legislative Session

According to a joint press release, New York State Assembly Speaker Carl Heastie and Senate Majority Leader Andrea Stewart-Cousins announced late last week that the Legislature plans to convene session this week “to pass legislation related to the COVID-19 pandemic.”

Committee meetings are expected beginning today with session scheduled for the days following. All proceedings will be broadcast.

HCA is actively tracking legislation and weighing in with statements of opposition, support or recommended amendments, accordingly.

HCA Presses Congress for Direct Financial Relief

Congress is debating another coronavirus aid package, and it is imperative that home care receives vital stabilization funds as part of it.

As reported last week, the U.S. House of Representatives passed a $3 trillion aid bill. It is opposed by U.S. Senate leaders, who are seeking an alternative approach. All forecasts suggest that a new package — however it may look — is not conceivable until sometime in June.

HCA President and CEO Al Cardillo this week wrote a letter to all members of New York’s Congressional Delegation appealing for funds to home care in this upcoming aid package, noting that prior relief measures have yielded billions in support for hospital needs while “home care’s fiscal chasm” in COVID-19 relief “has been substantially unaided by these measures.” (Later this week, HCA will be issuing a grassroots advocacy campaign message for members to help amplify this message to New York’s Congressional Delegation. Please be on the lookout for this alert.)

Prior Congressional legislation has included loans and advance payment programs as well as some select funds for Medicare services but with little comprehensive support for providers of all home and community-based programs, including Medicaid services.

HCA strongly supports the financial aid target advanced by the National Association for Home Care and Hospice (NAHC) — who is calling for an increase in rates of 15 percent — but, we add, New York State providers face a unique toll at the epicenter of COVID-19, necessitating funds proportionate to the impact they’ve faced.

We conservatively estimate that impact to be approximately $200 million — a baseline, threshold amount needed in the next aid package to stabilize providers for: the unreimbursed cost of personal protective equipment; workforce and caseload capacity fluctuations; higher operating and service costs; substantial depletion of service revenue due to service disruption; and other systemic factors.

Senator Collins Signals Bill on Telehealth Reimbursement

During a Senate Special Committee on Aging meeting on Thursday, May 21, Maine Senator Susan Collins said “I plan to introduce a bill soon to create a framework to reimburse for telehealth services provided by home health agencies.” The statement was prompted by testimony from witnesses on the need for telehealth. NAHC has been working to advance telehealth legislation in the Senate. The committee also discussed the issue of essential worker pay (see item below).

In Letter to Congress, 1199 and Home Care Groups Urge Funding

1199SEIU and several home care organizations, including HCA and many provider members, have sent a letter to leaders of Congress urging vital COVID-19 funding supports. (HCA reported on the then-draft letter in the May 4 edition of the Situation Report.)

Among the groups’ requests are funds for home care workers and for home care provider reimbursements. The letter is addressed to leaders of both houses: U.S. Senate Majority Leader Mitch McConnell and Minority Leader Charles Schumer as well U.S. House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy.

“We must ensure that the workforce caring for these homebound individuals has adequate resources, including proper personal protective equipment (PPE), access to testing, and enhanced compensation,” the letter states, adding that home and community-based providers “need additional resources to remain financially stable, to recruit and retain sufficient numbers of workers to care for homebound individuals, and to keep their workforce safe and healthy.”

Media Coverage of Cabrini-Funded COVID-19 Testing Initiative, Plus Launch Webinar Announced for May 28

In a press release shared with HCA members on Tuesday, HCA announced the upcoming launch of our initiative to train home care personnel on COVID-19 testing procedures.

The program — “Home Care Clinician Training for COVID-19 Testing” — is a joint initiative led by HCA and project partners at the Iroquois Healthcare Alliance and Mohawk Valley Health System. It is funded by a grant from the Mother Cabrini Health Foundation.

The initiative made headlines last week in Crain’s New York Business and Home Health Care News, which noted the program’s promise as a possible “national roadmap.”

“This is a situation where we are creating a home care infrastructure,” HCA President Al Cardillo said in the Home Health Care News report. “If you are ill because you have COVID symptoms, the last thing you should be doing is waiting in line in a congregate area for a test. This will enable doctors or facility care settings to contact in-home agencies to conduct tests for their patients.”

In a separate statewide launch announcement on Thursday, May 21, HCA invited home care agencies from across New York State to participate in a May 28 introductory webinar (10:30 to 11:30 a.m.) officially kicking off this exciting initiative.

Please read our separate story about this program, or register directly for the May 28 webinar here.

NBC News Report Features HCA, Selfhelp and Work to Broaden Access to Selfhelp’s Virtual Senior Center

HCA and HCA Member Selfhelp Community Services joined industry voices from around the nation in an NBC News report “Coronavirus concerns show increased need, demand for home care, experts say.”

The article explains the impact of COVID-19 on services, including what the future holds for home care. HCA noted the vital role of technology, and the need for reimbursement of telehealth. “We’re finding that telehealth is vital for reducing exposure in a time of crisis like this,” said HCA Communications Director Roger Noyes.

Selfhelp’s COO Russell Lusak, an HCA Board Member, discussed his organization’s pioneering Virtual Senior Center. Under a grant from the Mother Cabrini Foundation, HCA and Selfhelp are working collaboratively to make the platform available to all providers statewide. “That connection to other people is so important,” Lusak said. “It’s a great option for people that otherwise wouldn’t have the ability to go to a senior center. It’s such an incredible thing to see.”

HCA President Al Cardillo, Colleague Association Leaders Join AARP NY LiveStream on COVID-19

On Wednesday, May 20, HCA President and CEO Al Cardillo joined colleagues from groups representing the full continuum of eldercare services on a LiveStream Q&A hosted by AARP New York, fielding questions from viewers on Facebook. An archive is available for streaming on AARP’s Facebook page.

The panel was moderated by AARP New York State Director Beth Finkel. In addition to Cardillo, panelists included: AARP New York NYS Legislative Director Bill Ferris; LeadingAge New York President James Clyne; Long Term Care Community Coalition Executive Director Richard J. Mollot; and 1199SEIU New York Vice President and State Director of Policy and Legislation Helen Schaub.

The session covered a range of issues, including testing capacity, an evaluation of the state’s response efforts, funding and other needs related to COVID-19 and what the future of eldercare services holds in a post-COVID-19 environment.

NYS Recognition of NPP Authorizations Still Awaits Confirmation  

While the federal government has opened up permanent allowances for non-physician practitioners (NPPs) to authorize home care, HCA has repeatedly sought clarification on whether the state is likewise following suit with overlapping authorizations. This includes clarification we’ve sought on whether the state will permit all three of the federally-recognized NPP disciplines to issue orders for home care: nurse practitioners, physician assistants, and clinical nurse specialists.

HCA again reached state Department of Health (DOH) officials over the past week for DOH’s word on the matter and we were assured that a Dear Administrator Letter or other state guidance is in development.

HCA has called on officials to fast-track this guidance so that providers can act on the kind of flexibility needed — now — for care planning efficiency during the COVID-19 crisis.

Adult Social Day Care

DOH has posted questions and answers related to providing adult social day care services telephonically. The guidance is here.

Sick Leave Law 

DOH has released guidance on the applicability of New York’s COVID-19 sick leave law for employers of health care employees. It is here.

Among other important information, it includes the following:

If an employer directs a health care employee not to work or prohibits a health care employee from working because the employer suspects or confirms that the health care employee has been exposed to COVID-19, exhibits symptoms of COVID-19, and/or is diagnosed with COVID-19, the health care employee shall be deemed to be subject to a mandatory order of quarantine from the Department of Health. Accordingly, the health care employee is entitled to sick leave as required by New York’s COVID-19 sick leave law. Further, the health care employee does not need to provide the employer with any additional documentation to receive sick leave as required by New York’s COVID-19 sick leave law.

The guidance also gives criteria that must be met for an employer to require a health care employee who has been exposed to COVID-19 to return to work prior to the end of a 14-day quarantine or isolation period if the employer can demonstrate a staffing shortage.

OIG Audit of CARES Act Funds

The federal Office of Inspector General (OIG) has posted its updated Work Plan to include an audit of CARES Act Provider Relief Funds.

This work will examine the effectiveness of the U.S. Department of Health and Human Services (HHS) controls over the awarding and disbursement of $50 billion in Provider Relief Fund (PRF) payments to hospitals and other providers. It will seek to determine whether HHS controls over PRF payments ensured that payments were correctly calculated and disbursed to eligible providers.

More information is here.

OSHA

The Occupational Safety and Health Administration (OSHA) has published new guidance requiring employers covered by OSHA’s recordkeeping standards to determine whether employees have contracted COVID-19 while at work.

The guidance is here.

Starting May 26, OSHA is requiring all employers to record all COVID-19 cases that:

  • Are confirmed by at least one positive test (as defined by the CDC involving a respiratory specimen that tested positive for SARS-CoV-2, the virus that causes COVID-19).
  • Are work-related.
  • Cause employees to seek medical treatment beyond first aid, result in lost work days or restricted duty or cause loss of consciousness or death.

Providers are advised to frequently check OSHA’s webpage for updates.

HCA will be holding a training on OSHA requirements related to COVID-19 on Friday, June 5. Registration will be announced soon.

Workers’ Compensation

The Workers’ Compensation Board has adopted an emergency rule to allow reimbursement for COVID-19 testing when there is a claim for workers’ compensation benefits due to workplace exposure to COVID-19. This emergency rulemaking is effective for 90 days from May 18, 2020.