The Lead May 18, 2021 - LeadingAge Illinois

Nursing and Rehabilitation:
Duke Margolis Center for Health Policy Brief Published
AHRQ COVID-19 Nursing Home Action Network
AARP Nursing Home Dashboard

Independent/Subsidized Housing:
HUD Discusses New REAC Protocol; LeadingAge Calls for Stronger Risk Mitigation during Inspection Restart

Home and Community Based Services (HCBS):
OASAC Recap

Home Health and Hospice:
Provide Feedback on Hospice Payment Rule

Other:
IAMHP Complimentary Medicaid Medicare Alignment Initiative (MMAI) Billing Webinar

Top Stories:

From the Desk of Karen Messer, President and CEO
Tomorrow at 11 a.m. CST, join LeadingAge for a virtual program, “Investing in Care: Meeting the Needs of Older Americans and Their Families At Home.” You will hear from Katie Smith Sloan, president and CEO of LeadingAge, Kara Allread, senior vice president and CEO of Brethren HomeCare, Dr. Brandi Derr, director of programs at Rogerson Communities Adult Day Health Programs, and David Totaro, chief government affairs officer at BAYADA Home Health Care. These leaders will provide data and stories from the front lines of aging service, detailing how difficult it is for older Americans and their families to access care and services in their homes and communities. Register here to attend.

With gratitude,

Karen

Provider Relief Fund FAQs
As it stands right now, providers have until June 30, 2021 to spend all Provider Relief Funds. Members should make sure they have registered in the reporting portal. By doing this, you will receive communications from HHS once the reporting portal is open for report submission. LeadingAge has a short article with this information.

Largest CDC COVID-19 Vaccine Effectiveness Study in Health Workers Shows mRNA Vaccines 94% Effective
Last Friday, the CDC put out a press release on the largest CDC COVID-19 vaccine effectiveness study in health workers, which shows mRNA vaccines to be 94% effective. The study was released as an MMWR, that examined the interim estimates of vaccine effectiveness of Pfizer-BioNTech and Moderna COVID-19 vaccines among health care personnel at 33 U.S. sites from January – March 2021. The first U.S. multisite test-negative design vaccine effectiveness study among HCP found a single dose of Pfizer-BioNTech or Moderna COVID-19 vaccines to be 82% effective against symptomatic COVID-19 and 2 doses to be 94% effective. The mRNA vaccines are highly effective at preventing symptomatic COVID-19 among U.S. HCP. High vaccination coverage among HCP and the general population is critical to prevent COVID-19 in the United States.

This new CDC study adds to the growing body of real-world evidence (outside of a clinical trial setting) showing that COVID-19 mRNA vaccines authorized by the Food and Drug Administration (FDA) protect health care personnel (HCP) against COVID-19. This assessment, conducted in a different study network with a larger sample size from across a broader geographic area than in the clinical trials, independently confirms U.S. vaccine effectiveness findings among health care workers that were first reported March 29. Data for this assessment come from a network covering 500,000 HCP across 33 sites in 25 U.S. states, providing additional robust evidence that mRNA vaccines are effective against symptomatic illness in real-world conditions.

COVID-19 Vaccine Social Media Toolkit
The CDC updated the COVID-19 vaccine social media messaging toolkit. The page includes sample Facebook messages, Facebook digital resources, sample Instagram messages, Instagram digital resources, sample Twitter messages, and Twitter digital resources for the following topics: about the COVID-19 vaccines, vaccine benefits, vaccine FAQs, vaccine safety, what to expect after vaccination, and vaccine effectiveness.

LeadingAge National Weekly Updates
LeadingAge National has a recap of activities and issues involving various member segments from the last week.

Vaccination as a Condition of Employment
The long term care pharmacy partnership program began vaccinations of residents and staff the week of December 28, 2020. Now five months later, we have learned a lot, including the percentages of staff declining the vaccinations. This has led some members to mandating the vaccine as a condition of employment.

Westminster Village in Bloomington mandated the vaccinations early on for staff and received about 98% compliance on their campus. Recently, Christian Horizons also made the decision to mandate the vaccinations for employees.

A number of states, including Illinois have proposed legislation that would restrict an employer’s right to mandate the vaccine and require proof of vaccinations. Hinshaw and Culbertson, LLP says that it will be very important for employers to stay updated on what state and local requirements may come to pass that would change the discussion on this. The two bills in Illinois include one that would require the vaccine for employees of nursing homes, hospitals and veteran’s homes if the facilities made the vaccine available to the employees. The second Illinois bill prohibits employers from mandating the vaccine, and proof of vaccination.

Federal guidance does generally allow for employers to require employees to obtain a vaccination in order to return to the workplace. As a reminder, below is content from an article we published in The Lead in January with information from Hinshaw and Culbertson:

There is no federal law or state law in Illinois, for example, that prohibits employers from requiring employees to obtain a vaccine. However, though no specific law exists on vaccinations specifically, a bright line mandate without exceptions may end up violating Title VII or the Americans With Disabilities Act. That is because Title VII places an obligation on an employer to provide religious accommodations to employees where an employee’s sincerely held religious belief conflicts with a work requirement (unless doing so creates an undue hardship). Additionally, the ADA requires an employee to engage in the interactive process and provide reasonable accommodation to qualified employees with a disability.

As you consider whether to mandate the vaccine, any policy you contemplate should contain an exception or potential for accommodation where required due to religious or disability reasons. It is less clear whether a reasonable accommodation exists that could exempt an employee from obtaining the COVID-19 vaccination, but that will be a case by case decision based on the position at issue and basis for the accommodation request.

Having answered whether an employer can mandate employees receive the COVID-19 vaccine, the next challenge for an employer is deciding whether the organization should do so. The answer to this question will vary for each employer, relying on factors such as availability of the vaccine, workplace culture, staff cooperation, the existence of a union, etc. Additionally, in deciding whether to mandate, an employer should give equal consideration to what the consequences for non-compliance will be for employees. Frankly assessing whether and how the policy will be enforced may assist in the decision of whether to implement a policy mandating the vaccine in the first place.

Nursing and Rehabilitation:

Duke Margolis Center for Health Policy Brief Published
This brief summarizes the current VBP landscape for SNFs, how VBP impacted SNFs’ ability to respond to the COVID-19 pandemic and provides suggestions to policymakers about designing more effective SNF VBP models for the future that look beyond just Medicare services, provide some financial reliability for providers and result in quality improvement.

SNFs have had limited opportunities to participate in VBP models, and most often are limited to pay for performance
Current models have had little impact on changing care delivery or quality improvement in SNFs
Current VBP models in health care have negatively impacted SNFs by reducing PAC utilization, not sharing in savings generated, and narrowing of provider networks within these models (e.g. ACOs, Medicare Advantage and bundled payment)
One positive during the pandemic was SNFs with previous VBP partnerships often used those relationships to access adequate PPE, testing, treatments, etc. when not otherwise readily available.

AHRQ COVID-19 Nursing Home Action Network
The HHS Agency for Healthcare Quality and Research posts materials used by the Project ECHO Nursing Home Initiative and other toolkits, articles, and materials of interest to nursing home communities on its Nursing Home COVID-19 Action Network page. Among a wealth of other resources, there is a page on Vaccine Confidence with videos, PPT decks, leadership training materials, and conversation guides.

AARP Nursing Home Dashboard
The AARP Public Policy Institute updates its Nursing Home Dashboard every four weeks using NHSN reported data to provide a snapshot of COVID in nursing homes, the impact on residents and staff – nationally and by state. Here is the most recent update.

Independent/Subsidized Housing:

HUD Discusses New REAC Protocol; LeadingAge Calls for Stronger Risk Mitigation during Inspection Restart
HUD’s Real Estate Assessment Center (REAC) joined a LeadingAge call for housing providers last week to discuss the new approach to physical inspections during COVID-19. Under Inspector Notice 2021-01, inspections will significantly increase starting June 1, and housing providers will receive both a 28-day and a 14-day notice. However, inspectors are not required to be vaccinated and will undergo testing only every 30 days. LeadingAge has sent a letter to REAC requesting stronger action to mitigate COVID-19 risk in senior housing communities, for example by requiring unvaccinated inspectors to get tested no more than 72 hours prior to inspection and by exploring alternate approaches for physical condition oversight, including remote video inspections.

Home and Community Based Services (HCBS):

OASAC Recap
The Older Adult Services Advisory Committee (OASAC) held their quarterly meeting on Monday afternoon in virtual format. LeadingAge Illinois members Sherry Barter Hamlin of the Voyage Senior Living and John Larson of Cantata Adult Life Services serve on the Committee. Jason Speaks of LeadingAge Illinois is also an appointee. John was the featured presenter in yesterday’s meeting to discuss his organization. Sherry presented last meeting.

Here is a recap of the meeting:

New Member:
Dr. June McKoy, MD Specializing in Gerontology from Northwestern University. Serves patients from the Clare, Wesley Place, and others. She is also a licensed attorney with a specialty in elder law.

New IDoA Staff:
Katherine Ostrowski is the new Illinois Department on Aging (DoA) Legislative Liaison and started two weeks ago. She came from the Illinois House. She joins Gloria Simmons in the legislative area.

Vaccinations:
Veronica Halloway from the Illinois Department of Public Health (IDPH) reported on the vaccination program.

Of the over 12.5 million in Illinois, 10.4 million has received at least one dose of the vaccine.
38% in Illinois are fully vaccinated.
Over 84% of seniors are vaccinated.
Death rates from COVID have drastically reduced for seniors, especially since January, 2021.
Illinois’ Health Equity Team:
- It is made up of IDPH, DoA, other agencies, and institutional and community-based partners.
- The Seniors Work Group is led by Dr. Damon Arnold, former IDPH Director.
- Group met weekly during the height of COVID and now meets monthly.
- Worked with Area Agencies on Aging to get homebound seniors vaccinated.

Cantata Adult Life Services:
John Larson, CEO of Cantata Adult Life Services, presented on his organization. He has been in the industry over 30 years. Cantata’s vision is to transform the face of aging. The organization has existed since 1920. They serve about 750 clients per year on campus and about 1,200 off campus.

The Take 2 Program serves over 500 in multiple states. It delivers scheduled and on-demand services billed by the day. It is in Illinois, Hawaii, and Minnesota. Most visits last under 30 min. It is less intrusive. They also call is assisted living at home or homecare sharing. Caregivers are getting better pay and a more stable schedule. Cantata will continue their commitment to middle market innovation and to disrupt homecare with Take 2.

DoA Communications:

DoA is updating their guidance for adult day and other community based services. CCUs will begin face-to-face visits again soon. The State is beginning to reopen.
DoA is working with Northwestern University Center for Healthcare Communications on a video/webinar on vaccine hesitancy.

Adult Day:
About four new providers have joined the program since the pandemic began. Of the approximate 75 providers, about 65 are open under limited capacity. They will continue to mask at this time.

DoA Legislation:

SB700 passed House Human Services Committee last week.
HB2566 was held up in the House, but the Department is looking for a bill to add an amendment to.
SB2133 is not their bill, but of interest to them. Now in the House.
HB158 not in their priorities, but important to them. They are working with Alzheimer’s Association on the required training from this passed bill.

America Rescue Plan:
DoA receiving about $50 million from the America Rescue Plan. Most targeted towards Older Americans Act funds. DoA is looking at the federal guidance. Additionally, also receiving an enhanced FMAP of 10% for April 1, 2021 through March 31, 2022 for expenditures. DoA has until March 31, 2024 to spend those dollars. They will use these dollars for the Community Care Program (CCP).

Finances:
DoA is current on payments and sending bills to the Comptroller’s Office daily.

MCOs:
DoA has been working with the Illinois Department of Healthcare and Family Services (HFS) to improve the number of referrals for home delivered meals. There has not been as many referrals for home delivered meals for MCO clients.

Emergency Senior Services:

This is funding to meet any unmet needs resulting from COVID. Has touched between 10,000-15,000 seniors.

Home Health and Hospice:

Provide Feedback on Hospice Payment Rule
LeadingAge will hold a feedback sessions to discuss the hospice payment rule. The session will be on May 20 at 1 p.m. and the rule comments are due on June 7. No registration is necessary, please just bring yourselves and your feedback. Please reach out to Mollie Gurian at LeadingAge if you have questions or would like to provide feedback on the rule but are unable to attend either session. Register here.

Other:

IAMHP Complimentary Medicaid Medicare Alignment Initiative (MMAI) Billing Webinar
This Illinois Association of Medicaid Health Plans (IAMHP) webinar is designed to provide guidance to

providers and is open to staff responsible for billing or staff who want to learn more about MCOs and IAMHP. During the webinars you will learn more about the MMAI program and expansion, MMAI billing, and provider resources. Below are dates and registration information:

Tuesday, May 25
9 a.m. – 10 a.m. CST

Wednesday, June 9
12 Noon – 1p.m.

Monday, June 21
10 a.m. – 11 a.m.

Tuesday, September 14
11 a.m. – 12 p.m.

Wednesday, October 6
1 p.m. – 2 p.m.