LeadingAge Illinois eNews

The Lead February 19, 2021

Table of Contents:
From the Desk of Karen Messer, President and CEO
Governor Proposes FY22 State Budget
Partners in Quality Virtual Visits Held with Reps. Windhorst, Spain, and Marron
Weekly TANs and Medicaid Pendings Update
COVID Test Positivity by County
Update to TB Testing and COVID-19 Vaccine
Provider Relief Funds Update
2021 LeadingAge Illinois Legislative Tracker
IDPH COVID-19 Webinars for Long Term Care and Congregate Settings
Vaccine Education Resources for Staff, Residents, and Families

Supportive Living:
Annual Reviews Update

Assisted Living:
Tell Congress: Seniors Need More Help in American Rescue Plan

Nursing and Rehabilitation:
IDPH Meetings Recap
LeadingAge Nursing Homes Monthly Roundtable Call
Opportunity for Long Term Care Nurses
Emergency Preparedness Requirements

Independent Affordable/Subsidized Housing:
Affordable Housing Update

Other:
Support the LeadingAge Illinois PAC
LeadingAge Coronavirus Update Calls

Top Stories:

From the Desk of Karen Messer, President and CEO:
Advocacy has always been a strength of our members.  Your efforts are unparalleled. As we are now well into 2021, we are proud to enter another year with our members united, using their collective voices to advocate for their residents, staff, and fellow members. 

Equipped with the 2021 LeadingAge Illinois Public Policy Priorities, we have joined members in holding nearly 20 Partners in Quality Virtual Visits already this year.  Our member-driven priorities, along with member experiences over the course of the pandemic, serve as the backbone of our advocacy efforts in 2021.  Our priorities are a living document that will evolve as we continue our advocacy work.  We look forward to working with you all in putting our priorities into action. 

With gratitude,

Karen

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Governor Proposes FY22 State Budget
Governor Pritzker delivered his FY22 State Budget Proposal in an address held virtually at 12 p.m. CST on Wednesday.  LeadingAge Illinois attended the virtual address as well as the Health and Human Services Budget Debriefing that followed. 

Even with the pandemic’s impact on the state, revenues have performed well and lessened the need for more drastic measures. Even so, the budget proposed by the Governor will still leave that state with a $5.5 billion bill backlog.

FY2022 Operating Budget Appropriations:

  • $95.5 billion
    • Healthcare: 30.7%
    • Human Services:14.7%
  • Expenditures:
    • Healthcare: 17.3%
    • Human Services:17.3%

Key Parts of the Governor’s Speech:
“The general funds budget I present today for Fiscal Year 2022 spends $1.8 billion less than FY2021. It reflects $400 million in additional cuts to appropriations, a hiring freeze, flat operational spending, full required pension payments, and the closure of unaffordable corporate loopholes. All in all, it reduces spending to meet projected revenues.” 

Housing Assistance:
“In May, I worked with members of the General Assembly like Senator Robert Peters and Representative Delia Ramirez to deliver the nation’s largest housing assistance program, providing $324 million in emergency housing assistance to more than 55,600 renters and homeowners across the state, keeping people in their homes and stabilizing the market for landlords. We dedicated a record $275 million to help pay utility bills for those suffering COVID-related income loss. Homelessness is never acceptable, but in a pandemic it’s downright barbaric.

Digital/Telehealth:
“Telecommuting, telehealth, remote learning, videoconferencing — this pandemic laid bare the need for reliable broadband across the state. Fortunately, in 2019, working with the General Assembly, I prioritized broadband with the most aggressive vision for high speed internet in the nation. Through our public-private Connect Illinois program, we’re connecting over 26,000 residents who had been left out of the digital revolution, and it’s redefined the healthcare, education, and economic opportunities for their communities. At least $50 million in additional state matching grants will be awarded this year, making substantial progress on our goal of universal access in 2024.”

State Budget – Health and Human Services Debriefing:
Sol Flores, deputy governor, led the Health and Human Services State Budget Debriefing.  Presentations were offered by:

  • Paula Basta, director of the Illinois Department on Aging (DoA)
  • Theresa Eagelson, director of the Illinois Department of Healthcare and Family Services (HFS)
  • Dr. Ngozi Ezike, director of the Illinois Department of Public Health (IDPH)

IDPH:

  • IDPH has a new mission statement. It includes language on equity. 
  • They have created a new Office of Men’s Health
  • Like the overall state budget, the IDPH budget is flat. 
  • $4.8 million to hire additional 50 nursing home staff for long term care regulation. 
  • $1 million for Alzheimer’s Disease research, support, outreach, and care.

HFS:

  • HFS is receiving $638.2 million less from GRF – it is filling that hole with the funds from the COVID-19 enhanced FMAP of $6.2%. This means there will be a sudden need i.e., “cliff” of $638 million for Medicaid once the enhanced FMAP expires.
  • Director Eagelson stated that through the enhanced match, they were able to draw down fund balances. 
  • The proposal includes $76.5 million for reimbursement rate changes beginning January 1, 2022.
  • Director Eagleson reported that their balanced budget does not forecast for lengthy payment cycle delays. 
  • HFS filed emergency rules and permanent rules on allowing Telehealth. 
  • No cuts to eligibility, benefits, or provider rates

DoA:

  • $1.4 in FY22 (Increase of 4.3% from FY21)
  • $29.4 million for rate increases (January 1, 2022) for the Community Care Program (CCP), to cover costs of homemaker services. 
  • $1 million to add assistive technology to the CCP
  • $32 million to address minimum wage increase for CCP and other programs
  • $11.3 million to expand home delivered meals.
  • $5 million increase for Emergency Senior Services Program

Keep in mind that this is the Governor’s proposed budget and it will be up to the Illinois General Assembly to pass a budget bill.  The heavy budget negotiating will begin in May, the last scheduled month of session.  LeadingAge Consultant, Matt Werner of Werner Consulting contributed to this report.  If you have any questions, contact Jason Speaks. 

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Partners in Quality Virtual Visits Held with Reps. Windhorst, Spain, and Marron
We are now 18 visits into our 2021 Partners in Quality campaign.  As you know, our visits this year are al virtual and serve as briefings allowing members and staff to discuss the issues and experiences of members during the pandemic and present the 2021 LeadingAge Illinois Public Policy Priorities.

This week, we had visits with three downstate legislators: State Representative Patrick Windhorst (R-118th District; Harrisburg), State Representative Ryan Spain (R-73rd District; Peoria), assistant minority leader, and State Representative Michael Marron (R-104th District; Danville). Special thanks to the following members for ensuring the visits were a success:

  • Sherry Barter Hamlin, president and CEO, Voyage Senior Living, Anna
  • Patrice Deblois, CFO, Voyage Senior Living, Anna
  • Matt Feucht, administrator, Apostolic Christian Skylines, Peoria
  • Brenda Yanosik, director of operations, Carriage Crossing Senior Living, Champaign

Sherry Barter Hamlin, president and CEO of The Voyage Senior Living has been with the Marion-based organization for over 20 years.  She is a former LeadingAge Illinois Member Legislative Leader Award recipient and is a strong advocate not just for her communities in southern Illinois, but for member communities statewide.  She serves on the Older Adult Services Advisory Committee (OASAC) and has also served on other statewide committees. 

Voyage has communities in Anna, Herrin, Marion, Murphysboro, Marion, and Ullin  Sherry told the story of the organization’s supportive living community in Anna, in Rep. Windhorst’s district.  Rep. Windhorst, after taking office in 2019, attended a Partners in Quality visit at the community to learn about supportive living.   After Sherry discussed the vaccination program, Patrice Deblois, CFO, presented the financial challenges COVID has brought onto providers.  She provided a detailed presentation and took questions from the representative. 

Since the pandemic began, Matt Feucht, administrator, Apostolic Christian Skylines, Peoria, has held Partners in Quality briefings with his U.S. representative, state senator, and now his State Representative.  Matt explained the organization’s experiences with testing, PPE, vaccinations and financial struggles providers in Rep. Spain’s district have faced.  Rep. Spain has been educated since taking office by LeadingAge Illinois staff and members, and has been an accessible legislator.  He thanked Matt for telling the story of his organization and that of his fellow providers.  “LeadingAge does a fantastic job of advocating and representing this industry.  I have always enjoyed working with this association in particular and I look forward to continuing to do so,” said Spain.

For Brenda Yanosik, director of operations at Carriage Crossing Senior Living, her visit with Rep. Marron was her second visit this month.  In addition to the Champaign community in Marron’s district, Carriage Crossing has communities in Arcola, Bloomington, Decatur, and will soon open one in Rochester.  Brenda informed the representative of issues and challenges providers have faced since the onset of COVID, including price gouging. 

We have another handful of visits scheduled next week and the campaign will roll on in March.  If you would like to take part and hold a virtual visit with your legislators, contact Jason Speaks.

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Weekly TANs and Medicaid Pendings Update
LeadingAge Illinois Consultant Matt Werner, Werner Consulting
The Illinois Department of Healthcare and Family Services (HFS) is making a strong effort to addressing issues beyond the current crisis by improving transparency. HFS deserves credit. HFS is posting a report of Transaction Authorization Numbers (“TANs”) with current status codes to give a detail level understanding of issues. More transparency is a step in the right direction. This report includes data through the week of February 16, 2021. There is a one week lag in data, so this data represents actions through February 11, 2021.

An individual TAN may include an application for Medicaid eligibility in addition to the request to approve an LTC admission. The weekly TAN report does not identify which TANs have pending application, but all at least represent a pending LTC admission. The weekly update here will focus only on admissions because of this while any update to the monthly report will include pending applications.

The backlog increased to 198 this week. There are no residents in provisional status for the last several weeks. Matt continues to strongly urge you to read both the HFS and Illinois Department of Human Services (HFS) postings on the new policy at these pages: Provider Notices and DHS Policy Manual.

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COVID Test Positivity by County
LeadingAge Illinois Consultant, Matt Werner of Werner Consulting, has provided his most recent update on COVID Test Positivity by County.  Click here for the report from January 28 to February 10.

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Update to TB Testing and COVID-19 Vaccine
As you may recall, we reported a few weeks ago on a recommendation from CDC that individuals must wait four weeks after the second COVID-19 vaccine dose to complete a tuberculin skin test (TST) or interferon release assay (IGRA) if the TST or IGRA cannot be placed prior to the vaccination. Knowing that most, if not all states require TB testing for residents and staff, LeadingAge was concerned about the impact of this recommendation on compliance. LeadingAge has determined, and confirmed with CMS, the following:

  • CDC’s recommendation for TB assessment/screening is a nationally-recognized standard that nursing homes must follow under F880. However, the recommendation to delay is also a CDC (nationally recognized) standard and therefore, the nursing home would not be cited under F880 for following the guidance on when to delay TST or IGRA.
  • States may have regulations in place that specifically state TB tests must be done upon hire, prior to beginning work, upon admission, etc. (rather than the more vague statement to follow nationally recognized standards). If this is the case, the state will need to address the CDC’s recommendation to delay related to COVID-19 vaccination. Click here for the Illinois Code. 

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Provider Relief Funds Update
Nicole Fallon at LeadingAge national wrote an article analyzing the final two Nursing Home Infection Control incentive payments.  There is no set due date for the first report but it may be in the next couple of months as the second report is due (as of right now) on July 31, 2021. For now, the reporting portal is open but only for providers to register. By registering, providers will be notified when the portal will begin accepting reports and the due date once it is set.

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2021 LeadingAge Illinois Legislative Tracker
The 2021 LeadingAge Illinois Legislative Tracker is now live on our website and will also appear in each edition of the Lead. The tracker will be updated weekly and as needed. There have been about 2,000 bills introduced so far and several hundred more anticipated as session gets into full swing. Additional bills will be added to the tracker as we review incoming introductions. When your time allows, please check the tracker and provide any feedback on bills that pertain to your organization. Your feedback assists us in developing the association position on legislation and with discussions we have with legislators and legislative staff on issues. You can submit comments and questions to Jason Speaks. 

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IDPH COVID-19 Webinars for Long Term Care and Congregate Settings
The Illinois Department of Public Health (IDPH) continues to hold weekly webinars on COVID-19 for Long Term Care and Congregate Settings. There are important updates and information shared on each webinar pertinent to LeadingAge Illinois member settings. There is also a Q&A during the sessions. Most webinars go from 1-2 p.m. Slides and recordings of the webinars are sent to participants afterwards and they will also appear in the Lead. 

Today’s webinar will include:

  • Definitions of outbreak
  • Scenarios of moving through the phases
  • PPE and optimization
  • Presenters will include Angela Tang and Christine Pate, an infection control practitioner for IDPH (joined in October, 2020) who covers the Edwardsville region. She has over 20 years of acute care experience. 

Register for the upcoming webinars:

February 19

February 26

There are high numbers of participants on each webinar, so if you have trouble getting in, email Michael Moore at IDPH. 

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Vaccine Education Resources for Staff, Residents, and Families
In order to encourage maximum vaccination participation, we are providing you with education and resources you can use with your staff, residents, and families. We will continue to provide updated resources as we have them.

The COVID -19 vaccine is now available, but vaccination along with following the CDC’s recommendation to protect yourself and others will offer the best protection from COVID-19 and stopping the pandemic. There are many questions regarding the vaccine and below are resources that you can share with staff, residents and families. The internet has various amounts of information regarding the vaccine; please make sure it is from a credible source.

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Supportive Living:

Annual Reviews Update
Kara Helton at the Illinois Department of Healthcare and Family Services (HFS) would like to remind providers that onsite annual reviews will not be scheduled until sometime after a provider is in Phase 3 of the Long Term Care Phased Re-opening process.  If your annual review findings from FY20 are pending, findings will also be issued when your building is in Phase 3.

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Assisted Living:

Tell Congress: Seniors Need More Help in American Rescue Plan
Congress is currently considering President Biden’s $1.9 trillion COVID-19 American Rescue Plan. Unfortunately, long-term care was only mentioned once in the entire bill, and provided a small amount of relief to be divided among all congregate settings–including prisons, jails, psychiatric hospitals, and other facilities. As this virus has made all too apparent, seniors are the ones most at risk and most in need of help. We are urging Congress to fix this oversight and specifically target relief to senior living communities to ensure seniors and those who care for them have what is needed to stay safe.

In recent months, senior care advocates have helped shine a light on the need for priority PPE, testing, and vaccines — ensuring that seniors and caregivers in long-term care settings were the first priority (#1A) for vaccines. Your voices make a difference, and we are calling on all senior care advocates to join us once again to make sure lawmakers hear from those in senior living facilities on the urgent need for more federal help so we can get our communities back to feeling like home.

Writing to Congress takes less than a minute. All you need to do is click this link and enter your contact information and click “submit letter.” Your message will be sent directly to your member of Congress and both of your senators.

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Nursing and Rehabilitation:

IDPH Meetings Recap
On Thursday afternoon, LeadingAge Illinois and the other associations had a couple meetings with the Illinois Department of Public Health (IDPH).  We had our standard weekly check-in meeting on COVID issues, but our quarterly meeting on regulatory and survey issues was held prior to that.

Here’s a recap of issues discussed:

Surveys:

  • There have reportedly been inconsistencies providers are seeing in what is cited from one region to another.  Alfonso Cano, bureau chief of long term care at IDPH, reported that in no instance should any rules be applied inconsistently, no matter the region. 
  • Surveyor Training:
    • Due to providers noting issues with surveyor lack of understanding/education on requirements, specifically infection control, Barb Gold, assistant deputy director at IDPH, has a goal for a uniform training for all surveyors.
    • An IDPH team is revamping surveyor orientation and licensure training programs. 
    • Department work groups have been convened, meeting weekly, to address revising surveyor education and training for current surveyors.  Staff from every region participate. 

RN Waivers:
The Department is drafting new forms, policies, and procedures to implement the new nurse staffing rules.  A new unit in the Department has been created which is devoted to staffing compliance. 

Vaccinations:
Jordan Hatcher at IDPH is working on linking up providers with long term care pharmacies for vaccinations after the Pharmacy Partnership Program (PPP) ends.  LeadingAge Illinois provided the Department with a listing of long term care pharmacies that members work with. 

Involuntary Discharge Rules:
IDPH is expected to renew the emergency rule prohibiting the involuntary discharge of a resident for lack of payment. 

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LeadingAge Nursing Homes Monthly Roundtable Call
On Tuesday, February 23, LeadingAge will be introducing a new call for nursing home members. The Nursing Homes Monthly Roundtable will take place the last Tuesday of every month at 1 p.m. CST and will include policy updates, expert insights, and opportunities for members to ask questions and share best practices. This month’s call will feature Evan Shulman from CMS. If you would like to be added to the mailing list for this call, contact Jodi Eyigor at LeadingAge. 

Opportunity for Long Term Care Nurses
The Center to Advance Palliative Care (CAPC) is recruiting nurses who work in long-term care settings for a new peer learning and support project, the LTC Nurse Leaders Circle. It is open to nurses of any level who work in any long-term care setting with current work in or simply an interest in improving access to palliative care services for residents. They can either be employees of facilities, or employees of hospices, ISNPs, or other entity. There is a preference for those who work in settings with a significant number of minority residents. Participants of this Circle get access to CAPC’s courses and resources (which can be used to obtain continuing education credits), as well as a chance to learn and share ideas and challenges with their peers across the country. Anyone interested can register via this link and there is more information in this flyer.

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Emergency Preparedness Requirements
CMS updated emergency preparedness requirements in 2019 and released guidance in September 2020 reiterating that providers who activate their emergency plans in response to an actual natural or man-made emergency were exempt from completing their next regularly required full-scale community based or individual facility-based exercise.

Remembering that outpatient providers (e.g. home health) are required to conduct one testing exercise per year and inpatient providers (inpatient hospice, nursing homes) are required to conduct two testing exercises per year, with testing exercises for both provider types alternating between full-scale functional exercises and exercises of choice (mock drill, table-top exercise, workshop).

If a provider activated the emergency plan in March 2020 due to the COVID-19 public health emergency, the provider is/was exempt from the next required full-scale functional exercise and would proceed with the exercise of choice on the regular schedule. LeadingAge asked CMS: will providers who continue to operate under the emergency plan once again be exempt from the full-scale exercise? The answer is no, there will not be a second exemption for a continuous emergency. Here’s an example:

  • A nursing home was planning to complete a full-scale functional exercise in June 2020.
  • The nursing home activated the emergency plan in April 2020 in response to COVID-19.
  • The nursing home was exempt from completing the full-scale functional exercise in 2020 and completed required exercise of choice in 2020.
  • Though the nursing home continues to operate under the emergency plan, the nursing home must complete the full-scale functional exercise in 2021 in addition to the required exercise of choice.

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Independent Affordable/Subsidized Housing:

Affordable Housing Update
Today’s update includes:

  • LeadingAge 2021 Priorities
  • LeadingAge Housing Advisory Group
  • CY 2021 Service Coordinator and Congregate Housing Grant Renewals

LeadingAge 2021 Priorities:
LeadingAge has released their 2021 Affordable Housing Priorities.  Click here to view them.  

LeadingAge Housing Advisory Group:
The group has five Workgroups to share information among members, to improve programs, and to inform LeadingAge advocacy to HUD and to Congress. More about the five Workgroups, including how to join them, is here.

CY 2021 Service Coordinator and Congregate Housing Grant Renewals:
Gail Burks from HUD shared HUD’s announcement that the application period for Calendar Year (CY) 2021 Service Coordinator in Multifamily Housing Program and Congregate Housing Services Program renewals will open in GrantSolutions today. 

Grantees will have 31 calendar days to submit the required documentation in GrantSolutions in accordance with the attached CY 2021 Annual Renewal Guidance.  The application period will close on Monday, March 22, 2021.

The availability of funding is contingent on the annual, congressional appropriations process. Moving forward HUD will make every effort to have as many of the actions within their control completed so funds can be disbursed as quickly as possible once they become available.

To address concerns, HUD evaluated different approaches to help streamline the application process and expedite the amount of time it will take for grantees to receive funds. After careful consideration, HUD decided to employ the approach used in CY 2018 and compress the application period. More detailed information is provided under CY 2021 Renewals Approach and in the CY 2021 Annual Renewal Guidance.

In the interim, Owners/Management Agents may request access to available Reserve for Replacement funds to cover expenses while awaiting new extension funds and ensure the continuation of this vital program. To do so, Owners/Management Agents must submit a loan request to their Account Executive in the Regional/Satellite Office. Please note that funds borrowed from other project accounts to cover expenses while awaiting new extension funds must be fully reimbursed to those other accounts with grant funds immediately upon the availability and access to the grant award.

CY 2021 Renewals Approach:
Grantees with Active GrantSolutions Awards:
All grantees with awards that were previously processed in GrantSolutions are eligible to apply for renewals without submitting a HUD-91186-A Form, Multifamily Housing Service Coordinator’s One Year Budget, if they chose to receive the amount of funding in their CY 2020 Approved 12-Month Budget. Grantees that choose this option will automatically receive the 1.3% COLA. Upon award, grantees that choose this option may modify Budget Line Items through the Amendment Process.

Grantees with New Ownership:
Grantees with new Ownership during the last CY must follow the full renewal process as described in CY 2021 Annual Renewal Guidance. All grantees must comply with the submission requirements in the CY 2021 Annual Renewal Guidance.

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Other:

Support the LeadingAge Illinois PAC
The LeadingAge Illinois Political Action Committee (PAC) is a bipartisan, voluntary, not-for-profit organization representing professional men and women in the field of older adult care and services. Affiliated with LeadingAge Illinois, the PAC was created to support LeadingAge Illiinois’ friends in the Illinois Legislature and also to gain access to those legislators who may not be current on issues affecting our profession.

Click here to support the PAC.

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LeadingAge Coronavirus Update Calls
LeadingAge is hosting online updates that will occur Mondays and Wednesdays at 2:30 p.m. Subscribe to “LeadingAge Need to Know” via communications preferences in your MyLeadingAge account to receive email updates. Register for the online updates to add these calls to your calendar. You can find an archive of all member updates here. 

Next week there will be three calls. With the U.S. House back and working on the next big relief bill, possible movement in the Senate on the bill, and Xavier Becerra’s hearing set in the Finance Committee, there’s sure to be lots to talk about next week. LeadingAge is hosting some experts you won’t want to miss, too. On Monday, they will talk with Dr. Bill Mansbach who will talk about employee mental health and share ideas on how we can combat mental fatigue over the pandemic. Wednesday will have returning expert, Dr. Monica Gandhi who will be on hand to talk about the new COVID-19 variants and what is ahead with the virus and vaccines, as well as herd immunity, and then on Thursday they discuss how COVID-19 has made a differential impact on older adults with dementia with Dr. Rebecca Edekmayer from the Alzheimer’s Association.

Also, if you’re a member of both LeadingAge Illinois and LeadingAge National, stay connected with other LeadingAge National Members and share information and resources through the MyLeadingAge Member Community: COVID-19. This is a place to connect with your peers to share and discuss everyday practices related to the coronavirus virus. Take a moment now to log into your my.leadingage.org account and join the group to stay connected. LeadingAge also has a COVID-19 webpage with the latest updates, information and resources for members.

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