The Lead January 12, 2021 - LeadingAge Illinois

Nursing and Rehabilitation:
CDC MMWR on Nursing Home Residents and Staff

Independent Affordable/Subsidized Housing:
Governor Extends Eviction Protections

Home Health and Hospice:
Home Health Value Based Purchasing Program Expanded

Other:
1135 Waivers Update
Paycheck Protection Program Second Draw
New on the LeadingAge Learning Hub, MDS and Reimbursement

Top Stories:

Vaccinations Update
Today’s testing update includes:

Share Your Vaccine Experience
Hinshaw & Culbertson LLP on Mandating the Vaccine for Employees
Governor’s Updates
CDC Shares Latest on Pharmacy Partnership, Reporting System
New Update on State-by-State Prioritization of Vaccines
Interview with Co-lead of the National COVID Vaccine Trials
CDC Listening Session
CVS Announces Office Hours:

Share Your Vaccine Experience:
As more COVID-19 vaccines become available, LeadingAge would like to have a better understanding of members’ experiences. Please take a moment to fill out this short survey by Wednesday, January 13.

Hinshaw & Culbertson LLP on Mandating the Vaccine for Employees:
Now that we have finally turned the page on 2020, and a COVID-19 vaccine is a reality, employers will be faced with deciding whether to mandate that employees receive the vaccine. Many senior living employers are asking whether they can, and should, have such a mandate. Recent guidance this month from the EEOC confirmed that Employers may generally require employees to obtain a vaccination in order to return to the workplace.

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 of 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 employer 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.

No easy decision lies ahead, that much is certain. Working now with the organization’s human resources team and management to discuss these options and considerations will ensure you reach the best decision for the organization and its staff.
Information provided by Aimee Delaney, Hinshaw & Culbertson LLP

Governor Pritzker’s Updates:
The Governor reported yesterday that 587,900 doses of the Pfizer and Moderna vaccines have been delivered to Illinois (478,175 doses to public and private healthcare providers outside of Chicago and 109,725 to providers in Chicago). The CVS/Walgreen’s Pharmacy Partnership Program (PPP), whose doses are pulled off the top before shipments are made, acquired about 231,400 doses to vaccinate staff and residents of long term care facilities in Illinois (172,500 outside of Chicago and 58,900 in Chicago).

Illinois as a whole has administered 334,939 vaccinations (36,867 by the pharmacy partnership and 298,072 public and private healthcare providers). Today, Illinois numbers will be posted on the IDPH website and updated daily. It will be live-updated and have data uploaded faster than the CDC website, according to the Governor.

IDPH reportedly will be allowing local health departments (LHDs) that have neared completion of 1A, to move into 1B. LHDs will communicate with the local public as they move through the 1A population. 1B will take many weeks to complete. The Governor will make a formal announcement this week on a statewide move to 1B. Anyone who opted out in 1A, can get vaccinated in a subsequent round. There are 3.2 million people in 1B. There were about 850,000 in 1A. The Governor has focused, in the 1B phase, in lowering the age and effecting equity.

“Vaccination is essential to us moving forward,” said Dr. Ngozi Ezike, IDPH Director on Monday during the Governor’s COVID-19 Briefing. She encouraged Illinoisans to post a photo on social media indicating they got the vaccination utilizing the hashtag #VaxUpIL.

CDC Shares Latest on Pharmacy Partnership, Reporting System:
The CDC told LeadingAge and a couple of other associations that first vaccine clinics have occurred or are scheduled at more than 12,500 nursing homes as part of the Pharmacy Partnership for Long-Term Care Program, and that there remain more than 800 nursing homes with which CVS, Walgreens, and state and local health departments are still trying to make contact. LeadingAge also heard an update on the Vaccine Adverse Event Reporting System (VAERS), a reporting tool for vaccine side effects that pre-dates COVID-19. An article on these updates is here.

New Update on State-by-State Prioritization of Vaccines:
The Kaiser Family Foundation released an update on state prioritization plans for vaccine distribution. Click here to view the update.

Interview with Co-lead of the National COVID Vaccine Trials:
Dr. Larry Corey, former president and director of the Fred Hutchinson Cancer Research Center, and the co-lead of the national trials for COVID vaccines, provided more clinical information and thoughts about helping overcome vaccine hesitancy on a recent LeadingAge Coronavirus Update call. Here’s an article summarizing his comments.

CDC Listening Session:
The CDC hosted a Listening Session for COVID Vaccination for Older Adults in the Community. LeadingAge brought forward many of the vaccination prioritization concerns that members have expressed, especially for those who serve independent living, affordable housing/ HUD, and HCBS populations. Ideas for new resources and support from CDC were solicited, and LeadingAge and other aging services associations provided examples and discussion. CDC representatives were very receptive and interested in ideas for new resources and support. LeadingAge, ASHA and Argentum were especially vocal in providing comment, ideas and points of discussion on the topic; CDC promised to follow up with states, pharmacy partnership representatives, and attendees of the call. An article summarizing the call and points discussion will be available here.

CVS Announces Office Hours:
Click here for more information. There is one today and the next is January 14 at 12 p.m. CST.

Testing Update
Our updates on testing include:

CDC updates Testing Guidelines for Nursing Homes
HHS Updates Point-of-Care Testing Reporting for Nursing Homes

CDC updates Testing Guidelines for Nursing Homes:
The CDC updated guidelines for nursing homes to include information and guidance on the recently released Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing. The “Options” guidance was released in early December and provided that quarantine for exposed individuals could be ended ahead of the recommended 14 days, if elected by local public health authorities based on local circumstances or resources. CDC recommended under the “Options” guidance that quarantine could be ended after Day 10 if no symptoms had been reported during daily monitoring, or after Day seven with a negative diagnostic test and no symptoms reported during daily monitoring. In the updated Testing Guidelines for Nursing Homes, the CDC stipulates that while the full 14-day quarantine period is preferred, nursing homes may consider the alternatives outlined in the “Options” guidance in order to “mitigate staffing shortages, space limitations, or PPE shortages.” Remember that a provider should check with local public health prior to implementing these strategies.

HHS Updates Point-of-Care Testing Reporting for Nursing Homes:
On December 26, the U.S. Department of Health and Human Services (HHS) walked back their requirement that nursing homes must report point-of-care testing to NHSN. This change did not eliminate the requirement for “labs” (including nursing homes) to report point-of-care testing data, but allowed for NHSN to simply be an option for reporting, with other options including a point-of-care testing platform and process established by your state.

The CDC updated the information on their site on December 28. Around that time, HHS updated the Lab Data Reporting Guidance by eliminating the language related to NHSN reporting. On January 8, HHS issued a newly updated Lab Data Reporting Guidance document that more clearly reflects the change, as excerpted below:

CMS-certified long-term care facilities may submit point-of-care SARS-CoV-2 testing data, including antigen testing data, to CDC’s National Healthcare Safety Network (NHSN). This CDC- and CMS-preferred pathway to submit data to CDC’s NHSN applies only to CMS-certified long-term care facilities. Test data submitted to NHSN will be reported to appropriate state and local health departments using standard electronic laboratory messages. Other types of LTC facilities may also report testing data in NHSN for self-tracking or to fulfill state or local reporting requirements, if any.

Value First Announces New Affiliation to Help Members Manage Expenses
Value First and HPSI Purchasing Services are pleased to announce the signing of a multi-year affiliation agreement effective January 1, 2021. Many LeadingAge members experienced unanticipated expenses due to the pandemic and are needing to find ways to balance their budgets. One way can be to utilize the free services of Value First, a LeadingAge member benefit. By partnering with HPSI, Value First and LeadingAge members can access market leading pricing with suppliers they know and trust. For more information or to find out how much your organization can save, contact Terry Romin at 224.230.7265. Read Value First Press Release.

Nursing and Rehabilitation:

CDC MMWR on Nursing Home Residents and Staff
The CDC posted an early release of a Morbidity and Mortality Weekly Report (MMWR) entitled Rates of COVID-19 Among Residents and Staff Members in Nursing Homes – United States, May 25 – November 22, 2020.

The report examines NHSN data on nursing home cases and HHS data on community prevalence for May through November 2020. Data analyses found that during the time period of May 25 – November 22, reported cases were comparable for residents (51.8% of all reported cases) and staff (48.2% of all reported cases).

Cases among residents and staff showed similar trends, increasing in June and July, decreasing in August and September, then increasing again in November. These trends were similar to population trends in the surrounding community. The report notes that while there were regional variances in cases and trends, in all regions, trends in nursing homes cases were similar to those of the surrounding community, suggesting that increases in community rates might influence nursing home rates.

The report recommends nursing home mitigation strategies include a comprehensive plan to monitor transmission in the surrounding community and minimize high-risk exposures within the nursing home. Notably, high-risk exposures include non-patient contacts among staff, including household and social contacts, with potential lapses in adherence to mask use and social distancing. The report presented the following strategies:

Educate staff on the risk of community exposure.
Ensure access to adequate PPE.
Adhere to CMS guidance for routine testing of staff.
Isolate newly admitted/re-admitted residents whose COVID status is unknown.

Independent Affordable/Subsidized Housing:

Governor Extends Eviction Protections
Governor Pritzker has again extended evictions protections. The extension is enacted until February 6. More information is available through contacting the Illinois Housing Development Authority (IHDA).

Home Health and Hospice:

Home Health Value Based Purchasing Program Expanded
CMS announced that CMMI would be expanding the home health value based purchasing program through rulemaking beginning no sooner than CY2022. The model is currently running in nine states and has resulted in an average 4.6% improvement in home health agencies’ quality scores and average annual savings of $141 million to the Medicare program. More details about the expansion can be found here and an overview of the results from the first three years of the model can be found here.

Other:

1135 Waivers Update
The public health emergency (PHE) has been extended ahead of the January 20 deadline. Effective January 21, the PHE has been renewed for another 90 days. This means that the 1135 federal blanket waivers are also in effect for another 90 days. Review the 1135 federal blanket waivers here. A CMS notice about a new tool is also coming on applying for 1135 waivers. To clarify, this tool is only needed when applying for an 1135 waiver at the state- or provider-level. The 1135 federal blanket waivers do not require application. More information on waivers and this tool are available here.

Paycheck Protection Program Second Draw
The Paycheck Protection Program (PPP) loans are expected to reopen for second draw loan applications this week. Organizations may receive a forgivable loan of up to $2 million provided certain conditions are met. It is recommended that those interested in a loan to start the process as soon as possible. See more information from LeadingAge.

New on the LeadingAge Learning Hub, MDS and Reimbursement
Check out this new QuickCast, free to members. The Impact of the Resident’s Voice on Medicare Reimbursement. In this 13-minute QuickCast, Jessie McGill, the curriculum development specialist at AAPACN, highlights the importance of completing scripted interviews on the MDS assessment and the impact skipped interviews can have on Medicare Part A reimbursement.