The Lead October 9, 2020 - LeadingAge Illinois

Life Plan Communities/CCRC:
Member Spotlight: Westminster Village

Nursing and Rehabilitation:
Project ECHO Update
Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes

Supportive Living:
Required Supportive Living Program Preadmission Processes Training
Phased Reopening Reminders

Independent Affordable/Subsidized Housing:
Affordable Housing Update

Home Health and Hospice:
Home Health and Hospice Distribution of Binax Cards

Other:
IDFPR Form for Reinstatement/Late Renewal for Nurse Professions
National Academies Releases Final COVID-19 Vaccine Report
State LTC Ombudsman Releases Guidance on In-Person Visits
State LTC Ombudsman Releases Guidance on In-Person Visits
Value First Update on Gloves

Top Stories:

CARES Act Funding Allocations Update
As we informed you previously, the Illinois Department of Healthcare and Family Services (HFS) recently issued the first allocations of the CARES Act funding for nursing homes and supportive living. HFS would like to remind providers that if for any reason your organization cannot or will not execute the Subaward Agreement (enclosed with payments), the CARES payment must be returned immediately to HFS at the following address:

Illinois Department of Healthcare and Family Services
Bureau of Fiscal Operations
Attention: Receipt Accounting
2200 Churchill Road, A-2
Springfield, Illinois 62702

The deadline for the Round 1 budget submissions will be extended to October 13 for all provider types receiving funds. Much more information will be provided soon by the Department and they report that they are working to create and post on-demand type videos to help providers with the portal and other frequently asked questions. HFS will send a budget template out with notices. It will be due back seven days from the time it is sent out. It is required that the budget amount equal the award amount.

At our weekly meeting with HFS yesterday, they gave an example of why a provider would not have received a payment in the first round as being if the provider did not submit PBJ reports for the fourth quarter in 2019. The data is needed to incorporate into the payment methodology.

Partners in Quality Virtual Visit Held with Office of U.S. Rep. Danny Davis
LeadingAge Illinois held a Partners in Quality Virtual Visit with the U.S. Representative Danny Davis (D-7th District; Chicago) on Wednesday morning. The focus of the meeting was senior housing ans the impact COVID-19 has had on older adult care and services.

Special thanks to Ralph Gaines, CEO, Dave Opitz, senior director of mission services, and Greg Watson, director of housing operations from Embrace Living Communities for educating the representative on affordable housing and the needs of providers and residents.

Embrace Living Communities has four communities in the 7th district: CASL Senior Housing, Greencastle of Garfield I, Greencastle of Garfield II and North Orchard Place. Ralph gave a background of the organization, the communities in the 7^th district and the experiences of senior housing providers during the pandemic. Those experiences have included unbudgeted costs from PPE and cleaning to extra staff. Embrace urged the representative to continue to push Congress to pass COVID relief.

Rep. Davis has visited communities in the district, including CASL and LeadingAge Illinois members have met with him previously in his D.C. office during past LeadingAge Capitol Hill Visit Days. “The senior population is expected to grow. We still have a large number of people who are fortunate enough to reach those golden years and they need good living quarters. We try to be engaged and involved in the whole process of making sure that happens, so we thank you very much,” said Rep. Davis in the Wednesday meeting. “There is no group that is more important to me than those golden age people. We will do everything we can in the world to protect the health and safety and well-being of our senior citizen population. I appreciate the effort and positions taken and we will continue the fight.”

State and Federal Levels Encourage Flu Vaccinations
The state and federal levels each have released information on the importance of flu vaccinations.

The Illinois Department of Public Health (IDPH) issued on memo on Wednesday to provide long-term care facilities and other residential health and living facilities with current guidance for preventing and controlling influenza cases and outbreaks and with information on the reporting requirements in the event of a suspected or confirmed influenza outbreak. Click here for the memo.

Ngozi Ezike, MD, director of IDPH urged Illinoisans to get flu shots during Wednesday’s COVID-19 briefing. The Department has created a social media campaign with the hashtag #sleeveup.

At the federal, the U.S. Department of Health and Human Services (HHS) kicked off the Fight the Flu Vaccine Campaign. HHS has developed this set of tools to spread the word – Getting an annual flu vaccine is more important than ever this fall. #FightFlu by getting vaccinated today. Say #BooToTheFlu: During the month of October, use #BooToTheFlu to encourage others to get their flu vaccine by Halloween. More Info: “Boo To The Flu” Toolkit.

BinaxNOW Training Today at 3 p.m.
Abbott will be holding an educational webinar today from 3-4 p.m. CST this in support of their BinaxNOW COVID-19 tests. These webinars are designed to reinforce the Training Toolkit and highlight key points that should be kept in mind during BinaxNOW COVID-19 and NAVICA implementation. Click here to register. For additional training videos and documents, please visit the BinaxNOW™ COVID-19 Ag Card and NAVICA™ App Set-Up and Training portal.

Governor’s COVID-19 Briefing Recap
Each week, Governor Pritzker gives a briefing on COVID-19 to give updates and information on the pandemic and Illinois’ response. LeadingAge Illinois monitors the briefings for information pertinent to members. This week, the Governor gave the briefing on Wednesday from his home as he is still working from home due to a staff member recently testing positive for COVID-19.

Here’s a recap of some of the information the Governor shared on Wednesday:

Cases:
There are over 307,641 total cases of COVID-19 in Illinois with over 8,878 deaths.

Hospitalizations:
On Wednesday, there were 1,679 in the hospital with 372 in the ICU and 165 on ventilators.

Positivity Rates:
Illinois had seen promising declines in nearly every region at last briefing, except Region 1, which has seen consistent increases. They are not at 8.6% and entered tighter mitigation on October 3. Region 3 is the only region to flip from an increase to a relatively stable rate. Region 4has required heightened mitigation since late August. They fell from 10% to levels between 7-8% for weeks and dropped to 6.3% as of Wednesday. If they sustain a below 8% rate, they could return to looser mitigation today. Regions 5 and 9 are now stable, but have went from a decrease to an increase.

Testing:
The state has now completed over 6 million tests and is completing an average of 60,000 per day. Illinois was the first state to reach 5 million tests. There are still no-cost testing sites to get tested.

State Finances:
The Governor asked state agencies to come up with 5% cut in operating expenses for this year and another 10% for next year. Agencies looking at how to do the least damage and are looking at grant programs, personnel, and hiring.

CMS Announces New Repayment Terms for Medicare Loans made to Providers during COVID-19
CMS announced a one-year grace period for repayment of loans/advance payments received by providers. Now, payments are to begin one year from the issuance date of each provider or supplier’s accelerated or advance payment. The amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program was passed by Congress and signed into law by the President as part of the Continuing Resolution.

The Medicare loan program had allowed CMS to make advance payments to providers and is typically used in emergency situations. Under the Continuing Appropriations Act, 2021 and Other Extensions Act repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment.

CMS issued $106 billion in payments to providers and suppliers in order to alleviate the financial burden healthcare providers faced while experiencing cash flow issues in the early stages of combating the COVID-19 Public Health Emergency (PHE). For more information, CMS released a Fact Sheet and FAQs related to the Accelerated and Advance Payment Repayment and Recovery terms.

Provider Relief Funds Update
The application process for Phase 3 opened this week and will remain open until 10:59 p.m. CST on November 6. Phase 3 is open to all providers who have applied before and received a full 2% General Distribution, in addition to all other previously eligible providers.

There are two newly eligible groups for this application:

behavioral health providers including those who are exclusively private pay and/or accept commercial insurance, and
providers who opened/began delivering care in the first quarter of 2020.

Providers are encouraged to apply early as the distribution process is also different this time with a two-step process. The first step will be to review applicants to ensure they receive a full 2% payment in combination with any prior general distribution payments received.

After that, HHS will seek to “calculate an equitable add-on payment” for providers demonstrating a continuing need for funds. All providers seeking funds in Phase 3 must submit an application and this application will require providers to submit additional information to support their financial losses and increased expenditures due to the coronavirus. This Phase 3 Primer pulls together all the new information from the HHS website regarding the Phase 3 application.

HHS also clarified in its recently updated FAQs on Provider Relief that the Nursing Home Infection Control Payments can be used to hire and retain staff. The Terms and Conditions for the Nursing Home Infection Control limit use of payments to certain infection control expenses, including hiring staff, whether employees or independent contractors, to provide patient care or administrative support.

Payments from the Nursing Home Infection Control Distribution may be used to cover “hiring” expenses related to both recruiting new hires and the continued payment and retention of existing staff to provide patient care or administrative support.

The FAQs also provide additional details regarding the Phase 3 application process. The FAQs clarify that HHS will review all the applications prior to distributing any of the $20B from this tranche. So, this means these payments won’t make their way to providers until mid to late November at the earliest. The goal appears to be to ensure all eligible providers first get their full 2 % and then provide add-on payments to those who demonstrate continued need beyond what has been received to date.

Testing Update
Today’s testing update includes news from the state and federal level on antigen testing, collecting, ordering and reporting.

Outbreaks:
For long term care facilities with COVID-19 outbreaks or one case:

If they can collect their own specimens, they can test up to two rounds with the IDPH Lab. They will need to fill out the IDPH Lab form with their Outbreak Reporting System (ORS) or INEDSS number (obtainable from the local health department) to request swabs, VTM, and shipping materials. IDPH prefers they drop off or courier samples to an IDPH lab.
If facilities need help with specimen collection and testing, they can request an IDPH mobile team.

IDPH Guidance on Antigen Testing for COVID-19 in Long-Term Care:
Late Thursday afternoon, the Illinois Department of Public Health (IDPH) released guidance that addresses the use of COVID-19 antigen testing in long-term care facilities that is aligned with guidance released by the Centers for Disease Control and Prevention (CDC).

CDC Updated FAQ:
The CDC has updated their FAQ on testing to include new information. Providers should refer to the question on infection prevention and control measures for those who receive a positive antigen test result followed by a negative PCR result. Several factors need to be considered when determining how to proceed, and we know this has been a source of confusion/frustration with members and their health departments.

Information on Self-Collecting Anterior Nasal Samples for Health Care Providers:
The FDA issued a letter to health care providers recommending that health care providers give clear, step-by-step instructions to patients who, in a health care setting, are self-collecting anterior nasal samples for SARS-CoV-2 testing. Without proper instructions, patients may not collect an adequate sample for testing, which may decrease the sensitivity of the test.

Illinois Electronic Test Ordering and Reporting Portal:
To improve efficiency across Illinois Department of Public Health (IDPH) labs, the Department rolled out the IL ETOR (Illinois Electronic Test Ordering and Reporting) portal. IL ETOR is a web-based portal that will allow a provider to enter all the necessary data to submit a COVID-19 sample electronically from a laptop, tablet, or desktop.

The completed electronic submission form will need to be printed and accompany the specimen to the lab. The patient data is electronically transferred to the IDPH lab where the specimen will be processed. In IL ETOR, the provider will be able to view when the sample was received at the designated IDPH lab. Once testing is complete, the laboratory releases results into the portal as a PDF and they are immediately available for provider review and release.

Effective October 10, 2020, providers will be required to use IL ETOR if they are using the IDPH lab for COVID-19 testing. To facilitate registration, IDPH will contact any provider not currently using ETOR and get them enrolled. Results for samples received from providers not using ETOR could be delayed.

Samples submitted using the paper sample requisition form are only accepted if first cleared by the IDPH Division of Laboratories based on extenuating circumstances in which electronic submission is not possible or may be delayed due to acquisition of equipment or personnel. Facilities that continue to submit samples on the paper submission form may be subject to rejection if attempts have been made to enroll the facility on IL ETOR. These samples may be delivered back to the submitter. To enroll your site in the IL ETOR system or if you have further questions, send an e-mail to the Department.

Life Plan Communities/CCRC:

Member Spotlight: Westminster Village
In 2019, Westminster Village celebrated their 40^th anniversary. Westminster Village is a life plan community/CCRC with independent living, assisted living and skilled nursing (Martin Health Center). They will be opening a new memory care unit in the next two months. The oldest CCRC in McLean County, the campus is on over 40 acres of land. They have about 350 residents across the campus, but they are in the middle of an expansion project that will get them somewhere around 420 in the next nine months. The organization currently has about 225 staff.

Matt Riehle, chief operating officer at Westminster Village, is currently President of the LeadingAge Illinois Nursing Facilities Cabinet. Matt has been in the industry for about 23 years. “Having been in the industry for over 20 years I have seen staff that have worked with me that entire time provide the most fantastic care and offer support for some of our most vulnerable population and they do so without the recognition that they deserve and even in the face of challenging regulations and limited resources,” said Matt. He values the connections and relationships with staff, resident, and families. “We are blessed in this this industry to truly impact the lives of those we serve on so many levels,” said Matt.

Throughout his career, Matt has been a positive force in advocating for caring for the individual as a whole and respecting the aging process. In his advocacy efforts, he has fought for respect for staff and residents. “I feel that in general society is more open to seeing aging as a part of life to be respected and honored and same for those that are working to provide these services on a daily basis,” said Matt. “I think people used to think of the old nursing home as a place to go as more a last resort both for residents and staff, but today we have a vibrant and thriving community that celebrates life and aging and more people are becoming less biased to that old notion.”

In his over two decades in the industry, he has seen former staff become residents as well as staff that now have children working on the campus. It has brought him joy to see that tradition of providing care for the aging population carried on. Another source of joy for him is the ability to have an impact on staff, residents, and families. “We pray every day we do things right and when you can sit with that resident, family, or staff and know that they fully trust you to do what’s right you definitely have a sense of joy that I’m not sure is replicated in many other professions,” said Matt.

Nursing and Rehabilitation:

Project ECHO Update
The team at the University of New Mexico has made some changes to accommodate nursing homes that are interested in participating but raised questions.

Changes include:

Teams do NOT have to include the most senior staff or a medical director or director of nursing
Teams may consist of three members, rather than being held to four. Participants from a facility can take turns, as long as they bring information back to the full team. For example, a nursing home might have seven people participating in the learning collaborative. They could alternate weeks, with one three person team attending one week and a four person team attending the next week.
Minimum attendance to qualify for the $6,000 stipend from Provider Relief Funds is now 13 sessions.

A reminder that interested nursing homes may sign up at this link. ECHO staff are aware that some hubs are already reaching out to nursing homes. It is recommended to sign up through this link.

Telligen Long Term Care Office Hours October Event: Straight from the CDC: CMS Implements Stricter COVID Testing Requirements
On Thursday, October 15 at 2 p.m. CST, Dr. Nimalie Stone from the CDC will be presenting for Telligen’s interactive LTC Office Hours to review the current CMS guidance related to testing requirements for nursing homes and clinical laboratories. During this interactive Office Hours session, participants will learn more about the current testing regulations and required reporting processes. Dr. Stone and participants will share best practices to achieve success with these requirements in order to prevent the spread of COVID-19 to nursing home residents and front line staff. Click here to register.

Supportive Living:

Required Supportive Living Program Preadmission Processes Training
The Illinois Department of Healthcare and Family Services (HFS) would like to remind supportive living providers (SLP) that the HOPE Fair Housing Settlement requires annual training of SLP preadmission processes for applicable staff.

HFS held a webinar in September, 2019 to review the SLP Preadmission Processes. All staff involved with resident preadmission are required to receive this training. This includes, but is not limited to the manager, marketing staff, and nursing staff who complete preadmission assessments of residents. Click here for slides for your staff to review. This training should be documented just like any other staff training.

Additional Information:

Phased Reopening Reminders
The Illinois Department of Healthcare and Family Services (HFS) reminded supportive living providers (SLP) recently of information regarding the phased reopening process. An FAQ document has been developed and was shared with the Illinois Department of Public Health (IDPH) for review. Once revisions from IDPH are made, the FAQ will be distributed.

Here are additional details:

HFS spoke with IDPH during the development of the Phased Re-opening processes and it was determined that SLP providers should complete baseline testing. The Department reiterated this in our weekly call on Thursday afternoon. This was also noted during the September 9 webinar (slide 17).
If your building completed baseline testing months ago and has been doing routine staff testing since that time (more than just when symptoms are exhibited), baseline testing does not need to be repeated. If you have already provided attestation to Phase 2 or 3 without baseline testing, please inform your HFS Regional Supervisor.
SLP providers DO NOT USE THE IDPH REDCAP LINK at this time. The HFS Attestation form must be completed. See slide 18 on the webinar slides.
Attestation forms are sent to the HFS Bureau of Long Term Care Regional Supervisors. Please see page 5 of the Guidance regarding notification of residents and other groups after HFS confirms phase movement.
SLP providers must be in a phase for 14 days before submitting the Attestation form to progress to the next phase (Guidance 5). The count for phase progression begins on the date the HFS Regional Supervisors confirms your attestation.
When a COVID Region has been identified for mitigation, LTC providers, including SLP providers, are notified via SIREN. If you are not registered to receive SIREN alerts, click here.
SLP providers must follow the table and instructions on page 6 of the Guidance for tiered mitigation. Providers are not able to progress to the next re-opening phase OR reverse tiered mitigation requirements until 14 days after the mitigation is lifted. As long as there is not a resurgence in the metrics monitored by IDPH during this time, providers will be notified via SIREN that they can resume pre-mitigation practices.
Reporting Positive Tests to HFS. Kara Helton would still like you to report positive tests to HFS. Please note staff names should not be included, just the area in which they work. This form is available by contacting Kara and should be faxed back to her at 217.557.5061. They should not be e-mailed at HFS does not have a secure connection.

Independent Affordable/Subsidized Housing:

Affordable Housing Update
We have a couple affordable housing update today.

HUD Staff to Join Oct 26 Housing Advisory Group Call:
On Monday, October 26 at 11:30 a.m. CST, HUD staff will join the regular LeadingAge Housing Advisory Group call to provide an update on Service Coordinator funding. The staff will address the status of both calendar year grant extensions and COVID-19 relief payments for Service Coordinators. To submit advance questions or join the Housing Advisory Group call, contact Juliana Bilowich.

HUD Posts RAD updates:
HUD has posted an updated version of the RAD PBRA Quick Reference Guide to reflect program changes and frequently asked questions. HUD also posted a recording of its recent webinar responding to questions about the RAD COVID-19 Supplemental Notice. More information about the RAD webinar and the Notice is available here.

Home Health and Hospice:

Home Health and Hospice Distribution of Binax Cards
Please respond to this survey today for information requested by HHS in order to assist with the distribution of Abbott BinaxNOW testing cards. Completion of the survey does not guarantee that an agency will receive the Abbott BinaxNOW cards.

Other:

IDFPR Form for Reinstatement/Late Renewal for Nurse Professions
The Illinois Department of Financial and Professional Regulation (IDFPR) has released their form for Reinstatement/Late Renewal for Nurse Professions. The form is only applicable to nursing licenses that expired on September 30, 2020. Click here to access the form.

National Academies Releases Final COVID-19 Vaccine Report
The National Academies of Sciences, Engineering, and Medicine’s Committee on Equitable Allocation of Vaccine for the Novel Coronavirus has released the final 237-page “Framework for Equitable Allocation of COVID-19 Vaccine” report. Sponsored by NIH and CDC, the report is intended to help guide equitable allocation of a limited initial supply of the COVID-19 vaccine. In addition to an updated framework for equitable allocation of the COVID-19 vaccine, the final report includes recommendations for ensuring equity in distribution, administration, and access; for effective community engagement, risk communication, and strategies to promote vaccine acceptance; and for global considerations.

The release of this final report follows the September distribution of a discussion draft that sought public comments. The discussion draft assigned health care workers and high-risk seniors as recommended population groups for inclusion in Phase 1 in a four-phased approach to COVID-19 vaccine allocation.

Argentum was one of the associations that submitted comments to support this recommendation to the National Academies; this included a request that more specificity be included in the final report to ensure senior living residents and employees are included in these stated groups.

In a recent webinar that outlined the final report’s recommendations and phased approach, it was reported that senior living residents and employees remain under Phase 1 (see p. 8-9) in the Committee’s recommended vaccine allocation plan:

Phase 1a: Senior living employees are included under Phase 1a as “high-risk health workers” due to their “critical role in maintaining health care system functionality, their high risk of exposure to patients exhibiting symptoms of COVID-19, and their risk of then transmitting the virus to others, including family members.”
Phase 1b: Senior living residents are included under Phase 1b as “older adults living in congregate settings” due to their “high vulnerability to severe morbidity and mortality due to COVID-19.”

The report also indicates that for each phase, “vaccine access should be prioritized for geographic areas idenitified through the CDC’s Social Vulnerability Index or another more specific index” to account for equity. The report further recommends that HHS provide the necessary resources to ensure equitable allocation, distribution, and administration of the vaccine.

For more details, click here for the webinar slides.

State LTC Ombudsman Releases Guidance on In-Person Visits
The State Long Term Care Ombudsman has released guidance on in-person visits. Kelly Richards, the State Long Term Care Ombudsman, reported on the progress of the guidance at the weekly meeting LeadingAge Illinois attends with other associations and the state departments of Public Health and Healthcare and Family Services.

Value First Update on Gloves
Platinum Code is one of the Value First vendor partners. Click here for the updated price and availability list on gloves and information to pre-order needles and syringes. You will need your Vizient ID to receive the listed prices. You can reach out to Terry Romin group purchasing advisor for LeadingAge Illinois/Value First for your Vizient ID if needed. As LeadingAge Illinois and Value First continue to serve you, please reach out to Terry at 224.230.7365 to assist you for the needs of your community. Also, visit the Value First website or our resource page for up-to-date information for your community.