The Lead January 8, 2021 - LeadingAge Illinois

Nursing and Rehabilitation:
New CMS Survey Criteria
HHS/ASPR COVID-19 Outpatient Therapeutics Mini-Series
CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management

Independent Affordable/Subsidized Housing:
HUD Extends Service Coordinator CARES Act Payment Spending Deadline
Emergency Rental Assistance Program

Technology:
Comments on CMS Proposed Rules Related to Prior Authorization

Top Stories:

IDPH/HFS Weekly Meeting Recap
LeadingAge Illinois and the other associations had our weekly meeting the Illinois Departments of Public Health (IDPH) and Healthcare and Family Services (HFS) yesterday.

Here is a recap of the meeting:

Vaccinations:
IDPH told us that about 120 facilities have been vaccinated in Illinois. About 40% of staff accepted vaccinations and over 80% of residents have. LeadingAge Illinois continues to urge IDPH to ramp up a public awareness campaign on the vaccine, and we made that request again yesterday. We also have made this request to legislators in our Partners in Quality Virtual Visits, requesting that the legislators ask the Governor to rollout a campaign now.

CMS Mandated Training:
There is a mandated training from CMS, that IDPH has now made a requirement of assisted living and sheltered care (see today’s top story article: IDPH Files More Emergency Rules on Mandated CMS Training). Yesterday, we made another plea to the Department to extend the deadlines for this mandated training. IDPH indicated they will discuss this request internally and get back to us. We are pushing for an answer by next meeting.

Training can be done in group setting. If you do it in a group setting, your staff will not receive individual certificates, so you need to do a sign-in sheet and keep a attestation log of who’s completing it. If providers don’t have CCN number, then instead of signing up under provider, use the drop down menu and it is the last choice (educator, researcher and another choice).

IDPH provided this information:

Temporary Nurse Assistant (TNA) Program:
IDPH stated there are no plans for an extension beyond January 18, 2021. LeadingAge Illinois made another request to IDPH to not only extend this program, but expand it. This has been a request of legislators we continue to make in our virtual visits also.

Visitations:
LeadingAge Illinois reported to IDPH that families are getting anxious about visiting family members in facilities after they have been fully vaccinated. We will continue this discussion with IDPH to get more answers from them and CMS. Deb Patterson Burdsall, PhD, RN-BC, CIC, FAPIC, Infection Control Consultant for IDPH, read an email CMS response from Evan Schulman Director of the Division of Nursing Homes, CMS, Office of Quality Safety and Oversight, that he sent to an advocacy organization.

It read:
“Thank you for your tireless work to support nursing home residents. We are working hand-in-hand with our colleagues at the CDC and will discuss your email with them. I wanted to offer a quick comment to your suggestion below that, “Any resident that receives their full set of Covid vaccines needs to be granted the right to leave the facility with their family or friends without restrictions or the need to be placed in quarantine when they return to the facility.” Please note that residents always have the right to leave a facility. However, in order to prevent COVID-19 transmission, CMS does not recommend this and if a resident would like to leave the facility for more than 24 hours, we recommend facilities consider placing residents on transmission-based precautions upon return, which may include quarantine.

As the vaccine is deployed, we are evaluating its impact on COVID-19 transmission and all of our guidance, especially the visitation guidance. I can assure you, we want to enable more visitation between residents and their loved ones as soon as possible. Unfortunately at this time, even with the vaccine being deployed, the risk of transmission is still high and we need to maintain our existing vigilance and guidance to help prevent the transmission of COVID-19 as residents’ health and safety is our upmost priority. That said, the moment we’ve determined we can make a change, we will issue new guidance through a CMS memorandum that can be applied to all nursing homes nationwide.

Thank you again for your advocacy.”

Coverage of Testing:
LeadingAge Illinois again made a verbal request that the Governor sign an Executive Order mandating testing be deemed “medically necessary” so third party payers will cover the costs. We also made this formal request in writing. The Governor’s Office recently had a meeting with relevant agencies to discuss this issue. IDPH will report back next week.

CDC TB Testing Guidance (see also today’s top story article: TB Testing and COVID Vaccines):
LeadingAge Illinois requested more clarity on the TB testing guidance. IDPH reported that for healthcare personnel or patients who require baseline TB testing (at onboarding or entry into facilities) at the same time they are to receive an mRNA COVID-19 vaccine:

If vaccination has been given and testing needs to be performed, defer TST or IGRA until four weeks after COVID-19 vaccine 2-dose completion.
- All potential recipients of COVID-19 vaccination should weigh the risks and benefits of delaying TST/IGRA with their providers.

For healthcare personnel who require testing for other reasons:

Perform TB symptom screening on all healthcare personnel
Test for infection should be done before or at the same time as the administration of COVID-19 vaccination. If this is not possible, prioritization of test for TB infection needs to be weighed with the importance of receiving COVID-19 vaccination based on potential COVID-19 exposures and TB risk factors.
- Healthcare personnel with high-risk conditions for TB progression should be fully evaluated as soon as possible.
- Healthcare personnel without high-risk conditions for TB progression should proceed with contact tracing (i.e., symptom screening, chest radiograph or other imaging, specimen for microbiologic evaluation) but delay test for TB infection (TST or IGRA) if prioritized for receiving COVID-19 vaccination.
- All potential recipients of COVID-19 vaccination should weigh the risks and benefits of delaying TST/IGRA with their providers.

IDPH Bureau of Long Term Care Reorganization:
Alfonso Cano, the Bureau Chief of Long Term Care at IDPH, stated that the Department has been evaluating the processes of the bureau and will be reorganizing. He said the bureau was faced with a large complaint backlog and given the directive to resolve it ASAP. As of next week, they will have resolved over 1,000 in the backlog. The Bureau lost a lot of field staff due to attrition. They are working on getting the staff who have retired replaced and getting them in the field. We will continue to monitor any changes in the Bureau.

Vaccine Update
Today’s vaccine update includes:

Vaccine Dose Changes or Frequency Won’t Change Right Now
Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine
CVS Updates
Counts/Data
Updated LeadingAge FAQs on Vaccines

Vaccine Dose Changes or Frequency:
The U.S. Department of Health and Human Services (HHS) stated that there has been speculation regarding potential changes in dose amounts or frequency of EUA COVID-19 vaccines currently on the market. Recently, the FDA gave a definitive answer. The full statement is here, and here is an excerpt:

“We have been following the discussions and news reports about reducing the number of doses, extending the length of time between doses, changing the dose (half-dose), or mixing and matching vaccines in order to immunize more people against COVID-19. These are all reasonable questions to consider and evaluate in clinical trials. However, at this time, suggesting changes to the FDA-authorized dosing or schedules of these vaccines is premature and not rooted solidly in the available evidence. Without appropriate data supporting such changes in vaccine administration, we run a significant risk of placing public health at risk, undermining the historic vaccination efforts to protect the population from COVID-19.”

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine:
The CDC released an MMWR on the Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine in the U.S. Anaphylaxis is a severe, life-threatening allergic reaction that occurs rarely after vaccination. During December 14–23, 2020, monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (11.1 cases per million doses); 71% of these occurred within 15 minutes of vaccination. Locations administering COVID-19 vaccines should adhere to CDC guidance for use of COVID-19 vaccines, including screening recipients for contraindications and precautions, having the necessary supplies available to manage anaphylaxis, implementing the recommended postvaccination observation periods, and immediately treating suspected cases of anaphylaxis with intramuscular injection of epinephrine.

LeadingAge Coronavirus Call Featured U.S. Surgeon General Jerome Adams and CVS/Omnicare:
You can listen to the recording here.

Counts/Data:
Here’s a website from CDC that tracks COVID-19 vaccinations by state and county, as well as by selected populations such as long-term care residents.

Updated LeadingAge FAQs on Vaccines:
The LeadingAge Vaccine FAQs have been updated to reflect new information on 202 providers, whether pharmacy partners will immunize Independent Living residents in a CCRC/LPC if the state has included them in the partnership, how to switch vaccine partners, and details on the HHS announcement about the availability of vaccines for essential workers.

TB Testing and COVID Vaccines
The CDC has updated Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines. Currently Authorized in the United States. This guidance addresses a number of the frequently asked questions, such as dose intervals, mixing of COVID vaccines, mixing of COVID vaccines with other vaccines, allergic reactions and anaphylaxis, etc. Thanks to the experience of a LeadingAge member, they would like to draw your attention to a piece about vaccines and TB testing, tucked neatly into the last section of the document title “Laboratory Testing”.

The CDC recommends that individuals who have received a COVID-19 vaccine delay TB testing (tuberculin skin test or interferon gamma release assay) until four weeks after the completion of dose 2 of COVID-19 vaccination. Understanding that this may cause an issue with new hires and annual employee health certifications, LeadingAge has reached out to CMS for further guidance.

IDPH Files More Emergency Rules on Mandated CMS Training
The Illinois Department of Public Health (IDPH) this week filed emergency rules mandating providers take the mandated CMS training that originally was only for nursing homes. Alfonso Cano, Bureau Chief of Long Term Care at IDPH, told us yesterday in our weekly meeting that the Department made the decision to apply the rule to more settings, in addition to nursing homes, for consistency. The effective date of the rule is listed as December 18.

The rules apply to:

Nursing Homes
Assisted Living
Sheltered Care

These rules do not include Supportive Living. However, the Illinois Department of Healthcare and Family Services (HFS) stated after this afternoon’s IDPH Webinar that they believe this training would be beneficial for Supportive Living providers. It is not required for Supportive Living providers, but they recommend managers and clinical staff participate.

Here is a look at the rule requirements:

Require frontline clinical and management staff at facilities to undergo free COVID-19 training provided by CMS.
At least 50% of staff must complete this training by January 31, 2021.
All staff must complete training by February 28, 2021.
Persons hired after January 31, 2021 must complete this training within 14 days after hiring.
Topics addressed in the training program include:
Infection Control
Personal Protective Equipment
Disinfection
Screening
- Caring for individuals with dementia during a pandemic
Additional topics addressed in training for management staff include:
- Emergency Preparedness and Surge Capacity
- Emotional Health of Residents and Staff
- Telehealth for Nursing homes
- Preparing the facility’s vaccine delivery system.
Frontline staff required to complete this training include:
- Facility Medical Directors
- Nursing Directors,
- Treating Physicians
- Nurses
- Aides
- Rehabilitation Coordinators
- Social Service Directors
- Any Licensed Physical, Occupational or Speech Therapists
Volunteers, students, contractors, consultors, and caregivers who provide or engage in direct care or services to residents on behalf of a facility are also considered frontline staff and must complete the training program.

Click here for the Quality, Safety & Education Portal (QSEP).

In conversations and meetings with IDPH this week, LeadingAge Illinois has urged an extension of the training deadlines. IDPH said yesterday they will discuss the request internally and get back to us. We will keep you updated. If you have any questions, contact Ruta Prasauskas.

IDFPR Adopts New Rules on Nursing Practice
The Illinois Department of Financial and Professional Regulation (IDFPR) recently adopted rules changes to the Nurse Practice Act, effective January 4, implementing Public Act 100-513.

Here is a look at the rules:

Clarifies various aspects of licensure, scope of practice, and other criteria for advanced practice registered nurses (APRNs), registered professional nurses (RNs) and licensed practical nurses (LPNs).
RNs may delegate certain nursing interventions (e.g., administering oral or topical medication) to other RNs, LPNs or unlicensed personnel depending on the condition of the patient, the potential for harm, the complexity of the procedure/intervention being delegated, and the competency of the individual to whom the action is being delegated.
An RN may not delegate medication administration to unlicensed personnel (e.g., aides) in any hospital, institution or long-term care facility unless specifically authorized by law.

Upcoming LeadingAge National Meetings and Activities
There are a few important opportunities we wanted to hare with you from LeadingAge, which include:

Vaccine Town Hall for Assisted Living and Senior Housing Providers (Jan 12 at 11 a.m. CST)
LeadingAge and Abbott Training on BinaxNOW Testing Cards (January 12 at 12:00 p.m. CST)
LeadingAge Webinar on Vaccines and Vaccinations (January 21 at 1:00 p.m. CST)
LeadingAge 2021 Policy Action Forum (January 27 at 1 p.m. CST)

Vaccine Town Hall for Assisted Living and Senior Housing Providers:
Next Tuesday, January 12 at 11 a.m. CST, join LeadingAge, Johns Hopkins School of Nursing and Public Health, and the Baltimore City Health Department for a town hall for assisted living and senior housing administrators, managers, and staff. The event’s panel, including Ruth Link-Gelles from the Pharmacy Partnership Program and Dr. Joshua Sharfstein from Johns Hopkins, will address the science behind vaccines, vaccination distribution, messaging strategies, infection prevention, and other vaccine updates. Learn more and register here.

LeadingAge and Abbott Training on BinaxNOW Testing Cards:
Abbott will be hosting a training for LeadingAge and VNAA members on January 12 at 12 p.m. CST. The training will cover the Abbott BinaxNOW rapid testing cards, the affiliated NAVICA App, and the new at-home option for utilizing these tests. Register for the training here.

LeadingAge Webinar on Vaccines and Vaccinations:
LeadingAge’s Learning Hub will host a webinar on Vaccines and Vaccinations: Legal and Operational issues on January 21 at 1:00 p.m. CST. It will cover legal issues and considerations for vaccine planning and administration in nursing homes, life plan communities, assisted living, home health, and housing. Here is the link to learn more and register.

LeadingAge 2021 Policy Action Forum:
As 2021 begins, join LeadingAge at a live, virtual policy event (January 27 at 1 p.m. CST) to look forward to how the national association will continue to support aging services providers from across the continuum of care. You’ll get an inside view of how Washington, D.C. politics influence how progress gets made as a new Congress and Administration come into power and hear from LeadingAge leadership about the path for advocacy and policy in the year ahead. Special guest and health policy expert Dr. Adaeze Enekwechi will offer a primer on how politics and progress are shaped by what matters most to people, policymakers, and stakeholders—offering her perspective on what the transitions of power happening in Washington this month mean for our field. Register now to join the event.

Provider Relief Updates
We have some more Provider Relief Fund updates from the week. They include:

Nursing Home Infection Control Payments
Phase 3 Payments Delayed (Week of January 25)
Members with TIN Validation and Other Approval Issues
Phase 4 Application
PRF Reporting
New PRF Staff Positions

Nursing Home Infection Control Payments:
The November payments are awaiting OMB approval and once approved, could go out as soon. HHS anticipates a similar number of nursing homes to be eligible in this round as were eligible for October payments, so roughly 70% of the 13,000-plus nursing homes eligible for the program. HHS staff suggested the approach to the remaining payments may have changed and that the remaining $1.2 billion for the incentive payments will be distributed based upon November and December performance. Originally, the incentive payments were to consist of four monthly payments and one aggregate payment. The aggregate payment may no longer be occurring. This will hurt those nursing homes that were left out of early incentive payments because of data reporting issues but had low rates of infection and could have potentially benefitted from a payment that looked at performance over the four-month period.

Phase 3 Payments Delayed:
HHS indicated that further Phase 3 payments are delayed and now are not expected to release another round of payments until the week of January 25.

Members with TIN Validation and Other Approval Issues:
HHS has continued to try to resolve issues, but admits that many issues remain.

Phase 4 Application:
There will be a Phase 4 application as the recently-passed COVID Relief Bill requires it. The guidance for this next round is being drafted, but most likely will need to be completed under the new Biden Administration.

PRF Reporting:
PRF reporting is highly likely to be delayed including the launch of the reporting portal, originally scheduled to go live in mid-January with the first reports due February 15. While the lawyers are still pushing to meet the original deadlines, HHS leaders are 95% certain that the reporting will be delayed. You will recall that Congress passed some changes to the program especially redefining how lost revenues are calculated that will impact the reporting process and may be the cause for the delay. Should the reporting be delayed as staff are predicting, it is possible that the content of those reports and the process could also change under the Biden Administration

New PRF Staff Positions:
In good news, OMB approved two new positions within HRSA – Director and Associate Director – for Provider Relief Funds.

CMS Update on Part B Rates
CMS has updated the rates from the Medicare Physician Fee Schedule (MPFS) as a result of the changes from the Consolidated Appropriations Act passed at the end of last year. This includes:

A 3.75% increase in MPFS payments for CY 2021
Suspension of the 2% payment adjustment (sequestration) through March 31, 2021
Reinstatement of the 1.0 floor on the work Geographic Practice Cost Index through CY 2023
Delayed implementation of the inherent complexity add-on code for evaluation and management services (G2211) until CY 2024

CMS has recalculated the MPFS payment rates and conversion factor to reflect these changes. The revised MPFS conversion factor for CY 2021 is 34.8931. The revised payment rates are available in the Downloads section of the CY 2021 Physician Fee Schedule final rule (CMS-1734-F) webpage.

Governor’s COVID-19 Briefings Recap
LeadingAge Illinois continues to monitor the Governor’s COVID-19 briefings for information pertinent to member settings. Here is a recap of the Governor’s briefings this week:

Cases:
There have now been almost 1 million cases in Illinois and over 17,000 deaths.

Hospitalizations:
This week there were almost 4,000 in the hospital with COVID-19. Of those, over 800 were in the ICU and over 450 on ventilators.

Testing:
Over 13.6 million tests have been completed.

Vaccinations:

344,525 total doses have been delivered to Illinois (not including Chicago direct shipments)
114,075 were set aside for Pharmacy Partnership Program (PPP). This is outside of Chicago.
Illinois has now administered over 207,106 doses to date.
1/3 of healthcare workforce (outside of Chicago) have received the vaccine.
There has been a lower pace of deliveries from the federal government. Illinois is getting roughly 120,000 doses per week (60,000 for each vaccine: Moderna/Pfizer). Illinois has updated their January planning.
The Biden Administration has pledged to invoke the Defense Production Act to ensure the vaccine production grows significantly in the coming months.
1B begins when Illinois has substantially completed 1A. The reason for phases is the scarcity of the supply.
The Advisory Committee on Immunization Practices (ACIP) recommends 1B include seniors ages 75 and over and frontline essential workers. The CDC estimates the country has 30 million (3.2 million in Illinois) frontline essential workers and they include First responders, Educators, Postal service workers, Manufacturing jobs, Public transit workers, Food and agriculture workers, Grocery store workers, Congregate settings.
Illinois will strongly pursue equity in distribution. The average age of white COVID deaths is 81. The average age of black COVID deaths is 72, and the average age for COVID Hispanic deaths is 68. The Governor said the multi-generational institutional racism in healthcare has caused increased risk to these communities.
In Illinois, 1B will include ages 65 and older (one Illinois deviation from the ACIP recommendations).
Every available state resource will be employed to get the vaccine out to as many of the 12.7 million Illinoisans as possible (complete vaccine program).
The Illinois National Guard, who was used in the spring with testing sites, will help with mass vaccination site infrastructure throughout the state.
Illinois will be increasing the number of providers that can administer the vaccine.
AstraZeneca and Johnson and Johnson have applied for an Emergency Use Authorization.

Tier 3 Mitigation:
There was not an uptick in cases after Thanksgiving. Therefore, January 15, any region that meets the metrics for a reduction of mitigation measures can move out of Tier 3.

Nursing and Rehabilitation:

New CMS Survey Criteria
LeadingAge has provided us with the latest information on the new CMS survey criteria. To trigger an infection control survey, according to the new revised memo, a nursing home must meet case criteria (three or more new cases or one new resident case when previously they were COVID-free) plus one of the new criterion (multiple weeks of new cases, low staffing, etc.).

HHS/ASPR COVID-19 Outpatient Therapeutics Mini-Series
This series is offered through ECHO Institute and HHS/ASPR and is separate from the AHRQ ECHO National Nursing Home COVID-19 Action Network in which many members are participating. It has focused on monoclonal antibody treatments in long-term care, including where monoclonal antibody treatment fits in with the vaccine roll-out in long-term care. Recordings and resources for past sessions in this series are available here.

CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management
This is a special series, a part of the CMS National Nursing Home Stakeholder Call Series, aimed at addressing staff questions and concerns about the new COVID-19 vaccines and more. The sessions are moderated by CMS with speakers from CDC and representatives of front line staff and providers and more. The calls are recorded. Click here for more information.

Independent Affordable/Subsidized Housing:

HUD Extends Service Coordinator CARES Act Payment Spending Deadline
HUD’s Office of Multifamily Housing announced a spending deadline extension for CARES Act payments for grant-funded Service Coordinators. Originally ending on December 31, the new period of performance for these grants is extended through March 31, 2021. Next week, HUD plans to issue amendments to the Notices of Award for these grants, which will need to be approved by grantees in collaboration with Grant Specialists. More information here.

Emergency Rental Assistance Program
The U.S.Treasury has published a website for the new $25 billion Emergency Rental Assistance Program. The program will flow funds through state and local governments to help low income households pay for rent and utilities, including for arrearages. Owners of who do not receive ongoing rental assistance, including owners of low income housing tax credit housing, and their renters, are eligible for the program. More on the new website and the program are in this article.

Comments on CMS Proposed Rules Related to Prior Authorization
Nicole Fallon at LeadingAge along with CAST commented on proposed rules that would require Medicaid FFS and Medicaid managed care plans among other payers to set up electronic technology to share data between payers and providers along with submit and track prior authorization requests through a system that integrates with the provider’s EHR. Nicole wrote an article briefly summarizing the proposed rule requirements as well.