The Lead August 19, 2021 - LeadingAge Illinois

From the Desk of Angela Schnepf, President and CEO

Supportive Living:
COVID Reporting Update
2021 Supportive Living Program Cost Report
New HFS SLP Team Member

Nursing and Rehabilitation:
Third Doses Vaccine Doses and Changes to Weekly NHSN COVID-19 Vaccination Data Collection

Home and Community Based Services (HCBS):
Department of Labor Proposes Rule on Domestic Workers
Hospice and Home Health Open Door Forum

Other:
Third Vaccine Doses for Moderately and Severely Immunocompromised People
ERTC and the Infrastructure Bill

From the Desk of Angela Schnepf, President and CEO
As we reported via member alert yesterday, CMS will require nursing home staff be vaccinated against COVID as a condition of participation in the federal Medicare and Medicaid funding program. We are anticipating guidance from CMS, which we will share. At this point, we are waiting to learn what steps will be taken if homes do not comply. We will provide more details as they unfold at the federal level. Click here for the official press release from CMS.

The press release indicates the new regulation will be issued in September. The press release terms it an emergency regulation. Here are the topline points in the CMS press release:

High levels of staff vaccination link to fewer COVID-19 outbreaks among residents.
CMS will release an emergency regulation requiring vaccination for all staff in nursing homes sometime in September.
CMS will work closely with CDC, long-term care associations, unions and other stakeholders to advance policies that keep residents safe (presumably, this mandate).
CMS will continue to analyze NHSN data to monitor compliance and will deploy the QIOs to educate and engage nursing homes with low rates of vaccinations.
CMS expects nursing home providers to use all available resources to support employees getting vaccinated, including employee education and vaccination clinics.

Kindest regards,

Angela

Top Stories:

LeadingAge National Releases Statement on CMS Vaccination Mandate
In a statement right after the announcement that CMS will mandate COVID vaccinations for nursing home workers, Katie Sloan, CEO of LeadingAge National noted LeadingAge has already encouraged providers to make vaccine a condition of employment. However, she added that penalizing nursing homes by withdrawing or withholding funding is not the right way to increase vaccination rates and would be a tragic misstep.

In the upcoming Update Call on Monday, August 23, LeadingAge National will provide some strategies that members have used, to prepare for a mandate and how to handle considerations like exemptions and policies. Join us to hear from Christy Zeitz from Fellowship Square communities who will share how her staff is working to bolster morale amid trying times.

CDC Makes Announcement on COVID Booster Shots
The CDC issued a joint statement with other federal regulatory agencies on plans for an additional booster dose of the Pfizer or Moderna mRNA COVID-19 vaccines for all individuals previously inoculated with an mRNA vaccine, subject to the FDA conducting an independent evaluation of its safety and effectiveness. The statement follows the announcements by the CDC’s Advisory Committee on Immunization Practices (ACIP) recommending an additional dose of the mRNA vaccines only for those with moderately to severely compromised immune systems.

The initial recommendation for boosters would be for administration eight months after individuals receive their second dose of the vaccine, with booster doses potentially administered as soon as the week of September 20. Boosters would be available to anyone who had previously received an mRNA vaccine. Boosters are not currently planned for those who received the Johnson & Johnson (J&J) vaccine; the CDC is continuing to evaluate data on the effectiveness of the J&J vaccine and the need for boosters.

As seniors and workers in long-term care facilities were among the first to receive vaccines based on last year’s ACIP recommendations, they will also be among the first to be eligible for boosters based on the proposed 8-month timeframe following their second-dose. CDC data supports the focus on prioritizing long-term care facilities, with a study of 15,000 long-term care facilities showing the effectiveness of the mRNA vaccines dropping from 74% this Spring to 53% by July. A recent study of a third dose of the Pfizer vaccine found it be 86% effective for people over age 60.

Some other items from the national CDC call included:

There are no plans to bring clinics into any provider organizations, as was done with the original Pharmacy Partnership.
This has to happen now, but no one can activate any plans until the FDA and the ACIP make a recommendation about boosters. Right now, this has only happened for immunosuppressed individuals.
Most people will need boosters around 8 months after they were fully vaccinated.
Clearly CDC recognizes that aging services staff and residents are a top priority. CDC is working with provider associations, pharmacies and jurisdictions’ health departments to plan ahead.
It’s recognized that the ideal situation is on site clinics; the best way to make this happen will be good planning. Providers need to take the first steps to do this planning.
CDC reports that 95% of nursing homes have a plan in place now to obtain vaccines. the nursing home message is that their first line is work with their LTC pharmacies. But they too need to work proactively and make their own plan.
HHS recognizes it may be easier for larger providers with higher numbers of people to be immunized to negotiate onsite clinics; there’s special attention and focus to be sure small providers and rural clinic needs are addressed too.
Housing, Assisted living, memory care, CCRCs, adult day, PACE and all aging services providers who offer services in congregate settings need to begin now to make plans.
Providers need to do two things right now to get started: figure out as well as possible how many doses you will need; and reach out to retail partners to begin to discuss how to bring them in for clinics or, if necessary, arrange to bring people to them.
Planning can also include activating all the processes providers learned about in December – the spring. Consent forms, staffing clinics, setting up the space, communicating to families, etc.
HHS is still working on logistics. Provider experience from the original roll out is incredibly valuable. CDC is looking for our input on things to keep in mind and plan for.

IDPH Monthly Meeting Recap
LeadingAge Illinois and the other associations had our monthly meeting with the Illinois Department of Public Health (IDPH) on COVID issues.

Here is a recap of issues presented and discussed:

COVID Guidance:
The 14-Day Quarantine Recommendation is a recommendation, not a requirement. All wording in the guidance should have said “should” and not the one “must” according to an IDPH consultant. IDPH is waiting for additional CDC guidance. If the new guidance is more stringent, the IDPH guidance may be as well. Current IDPH guidance was written with caution due to drastic number of outbreaks in facilities and positive tests even in the vaccinated in the last two weeks. The current recommendation is for the newly admitted or re-admitted as well as those who may go out overnight, etc. Quarantine should be considered for the vaccinated, but definitely for the non-vaccinated.

If facilities do not follow the recommendations, there is a concern from the associations that facilities will be cited. IDPH said they can only fine deficiencies based on state and federal regulations. IDPH will investigate issues concerning infection control. IDPH recommends following solid practices to make sure you are making residents safe.

Vax Verify System:
The new system and portal is meant for individuals to access their own history. Third parties cannot use it. The associations asked for the State to examine a way providers can utilize this system to verify vaccinations.

PBJ Staffing Submissions:
IDPH has a meeting internally this week to look at integrating the aggregate data that facilities will be required to submit. The aim is to streamline to report on a quarterly basis. Fines take effect next year. The current plan is to have facilities submit data soon and work out any kinks and get a sense of what it looks like.

CMP Applications:
The goal to open applications is January, 2022. You need to create an account with the State to apply for grants. All information will be on IDPH website in CMP section. It will be up in the next two weeks.

TNA Program:
LeadingAge Illinois requested staffing assistance at this time such as the Temporary Nursing Assistant (TNA) program. We will continue to provide strong examples of the current staffing crisis to the Department, legislators, and administration. We have another meeting with IDPH this afternoon and will again urge solutions.

Mandated Vaccines:
The State has no plans at this time for mandating vaccinations of healthcare employees.

Here are some other questions asked and responses from the IDPH clinical consultant, which includes some hypotheticals:

Question: Is cohorting of residents permitted under IDPH rules on a Quarantine unit?

Answer: Ideally in a private room.

Question: When can providers cohort residents with unknown status?

Answer: Suggest not cohorting.

Question: Is the entire unit considered “affected” and therefore in quarantine (and therefore unable to have indoor or outdoor visits) if a CNA who worked the unit is now testing positive?

Answer: Determine who the CNA worked with (what list, co-workers, etc.) if the co-workers are in surgical masks OSHA considers it a higher risk exposure and then vaccination status determines course of action. Residents who were higher risk exposures are on quarantine regardless of vaccination status. Unvaccinated HCP, tested immediately and 5-7 days after exposure and quarantined. Vaccinated HCP, tested immediately and 5-7 days after exposure and may continue to work per CDC.

Question: What if it is not a positive test but a high risk exposure of that unvaccinated CNA as her husband has COVID (and she has been within 6 feet for many hours without either masked) and at this moment she is still testing negative? Does that high risk exposure put the unit in quarantine and cause pause in indoor and outdoor visits?

Answer: Don’t quarantine from a negative/asymptomatic person with a higher risk exposure.

Question: If an occupational therapist tests positive and she has been in two rooms on one unit and one on another providing direct care (close contact for greater than 15 minutes) in a mask and face shield, are both units considered affected and everyone is quarantined or can everybody but the three residents with direct exposure resume outdoor visitation? i.e. if there was not direct exposure, as occurred for the three residents, are the other residents on the unit still considered in quarantine?

Answer: With two affected units the facility is in outbreak.

Question: Would being in an N95 affect that decision about exposure levels to the extent that quarantine is not necessary?

Answer: Staff in N95s with eye protection are not considered a higher risk exposure.

Question: If the facility has a unit in outbreak status and all staff is in N95 and face shields, do visitors also wear N95s and Face Shields?

Answer: They can be made available for compassionate care and essential caregivers, but if a unit is in outbreak then only outdoor visits are allowed for residents not in isolation or quarantine.

Question: If a facility is in a county with greater than 10% positivity rate, are staff in N95s or just a surgical mask (understanding that all staff is in eye protection from greater than 5% positivity rate)?

Answer: Same as over 5%. Non-outbreak, surgical masks and eye/face protection unless caring for someone in isolation or quarantine for suspected or confirmed SARS-CoV-2. Outbreak- N95s and eye/face protection.

Question: Because turn-around has gotten to be greater than 24 hours with labs during the surge, is it appropriate to swab for PCR and use rapid tests for a first round so decisions about scope if response can be made but remain in pause for visitation until with PCR results?

Answer: Yes, rapid antigen tests can be used.

New Materials from CDC for SNF and Assisted Living Providers
The CDC shared materials that SNF and assisted living providers can use to support and encourage staff to be vaccinated. The new materials include posters, social media posts, and other items. In addition, CDC compiled this list of links of existing web resources for nursing home and, in some instances, other providers:

Help Set the LeadingAge Illinois 2022 Public Policy Priorities
The LeadingAge Illinois 2022 Public Policy Priorities Member Forums are your opportunity to provide input and help us set our 2022 Public Policy Priorities. In these free, one-hour virtual forums, LeadingAge Illinois staff will provide a recap of the spring legislative session, a landscape for the 2022 session, and provide other information and updates to give you the background needed to help us identify the top legislative priorities for the next year. Please come prepared to discuss your challenges and suggestions on how we can have a stronger impact in your day-to-day operations, and more.

Member Forums (all virtual):

Housing Forum
Tuesday, August 24
10-11 a.m.
Register Here

Supportive Living Forum
Wednesday, August 25
10-11 a.m.
Register Here

HCBS Forum
Tuesday, August 31
10-11 a.m.
Register Here

Nursing Facilities Forum (COMPLETED)

Life Plan Communities/CCRC Forum ( COMPLETED)

Assisted Living (COMPLETED)

You can also submit your feedback and recommended priorities via e-mail. Let us know the burdens and challenges that are impacting your community as well as potential legislative/regulatory remedies that can remove them.

Impending Deadlines
We want to keep you updated with reminders of items that have deadlines coming up. Check here each newsletter for updates.

August 20: Submit Comments on OSHA Emergency Temporary Standard. Deadline has been extended until August 20.
August 30: Funding of $103 Million from American Rescue Plan Dedicated to Reducing Burnout and Promote Mental Health in the Health Care Workforce. Applications for each of the funding opportunities are due August 30.

Supportive Living:

COVID Reporting Update
Kara Helton at the Illinois Department of Healthcare and Family Services (HFS) would like to remind providers to include individuals’ vaccination status in the comment column of the COVID reporting templates. If you need the templates, contact Kara. There is no need to include staff names, just their position, such as maintenance, CNA, etc.

2021 Supportive Living Program Cost Report
Click here for the most recent information on the 2021 Supportive Living Cost Reports.

New HFS SLP Team Member
The Illinois Department of Healthcare and Family Services (HFS) has announced a new staff member for the Supportive Living Program. LaTatia Danner, RN, is working in central office and will be assisting with a variety of projects and tasks. She’s sitting in on calls with Kara Helton as well and will o be visiting some communities to observe annual reviews and complaint investigations. She can be reached at 217.782.0558.

Nursing and Rehabilitation:

Third Doses Vaccine Doses and Changes to Weekly NHSN COVID-19 Vaccination Data Collection
Following the August 13 ACIP recommendation for additional vaccine series for moderately and severely immunocompromised people, the CDC has announced new questions on vaccine doses will be added to the data collection forms.

The main changes are: Question #2 remains the same, except it asks about the primary vaccination series; Added question #4 for facilities to report on the cumulative number of individuals eligible to receive an additional dose of COVID-19 vaccine. Added question #5 for facilities to report on the cumulative number of individuals who received an additional dose of COVID-19 vaccine (by manufacturer type). The CDC will be conducting training webinars in late August.

Home and Community Based Services (HCBS):

Department of Labor Proposes Rule on Domestic Workers
The Illinois Department of Labor (IDOL) has proposed amendments to its minimum wage rule, defining various aspects of the law as it applies to domestic workers. The rulemaking adopts the statutory definition of domestic worker established in the Domestic Workers’ Bill of Rights Act (persons who provide housekeeping/cleaning services, caregiving for elderly persons, or other household services) and clarifies that “hours worked” for domestic workers includes all time that the worker is required to be on the employer’s premises and is not completely relieved of all work-related duties. Bona fide meal breaks, rest periods, and sleep periods are not included if the worker is completely relieved of all job-related duties and is free to leave the premises, rest/sleep, or engage in other activities during those periods.

Employers must keep time and pay records for domestic workers they employ and pay overtime for hours worked more than 40 hours per week. The rulemaking also clarifies provisions for shared services (when a domestic worker provides services to two or more employers) and clarifies the circumstances in which an employer may take a credit for meals and lodging provided to a domestic worker.

The comment period for these rules is until September 27.

Hospice and Home Health Open Door Forum
The next Home Health, Hospice & DME Open Door Forum is scheduled for Thursday, August 26 from 1:00-2:00 p.m. CST. The agenda will cover the hospice FY2022 rule, hospice updates and public reporting, CY2022 home health PPS rule (comments close on 8/27), the home health quality reporting program updates, and updates to the Home Health CAHPS survey. To participate by phone, dial 1-888-455-1397 and use the passcode 8604468.

Other:

Third Vaccine Doses for Moderately and Severely Immunocompromised People
On August 13, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend an additional dose of the Pfizer vaccine for those 12 and older and of the Moderna vaccine for those 18 and older following a primary series in immunocompromised people. The ACIP took the vote after reaching the conclusion that the desirable consequences of the third dose for this population “clearly outweigh undesirable consequences in most settings.” The ACIP recommendations allow self-attesting moderately and severely immunocompromised people to receive a third dose. People will not need a prescription or a doctor’s signature to receive a third dose. As for the rollout of this decision, CDC staff said they have been working with pharmacies to be prepared should the Committee vote positively and the CDC is hoping these third doses can be rapidly implemented. An article about the ACIP’s decision is here.

Also,Medicare stands ready to pay for administering an additional dose of COVID-19 vaccine consistent with the FDA emergency use authorization (EUA). They will pay the same amount to administer this additional dose as they did for other doses of the COVID-19 vaccine (approximately $40 each). More information in the coming days about billing and coding.

For more information, View the FDA announcement and the CMS COVID-19 Provider Toolkit

ERTC and the Infrastructure Bill
The infrastructure bill that passed out of the U.S. Senate included language that provides for an earlier end to the COVID-19-related Employee Retention Tax Credit (ERTC). The bill would move the deadline for the ERTC to September 30 instead of December 31, 2021, ending eligible employers’ ability to claim the credit a quarter early.