The Lead October 2, 2020 - LeadingAge Illinois

Nursing and Rehabilitation:
NHSN Security Upgrade

Assisted Living:
Assisted Living Update
Update on Rapid Test Distribution and CLIA Waivers
Argentum Releases Essential Caregiver Toolkit

Independent Affordable/Subsidized Housing:
Take the LeadingAge Affordable Housing Survey Today!
HUD Issues First COVID-19 Relief Payments
LeadingAge Housing Advisory Group

Home Health and Hospice:
CMMI Announces Plan Participants for VBID

Home and Community-Based Services:
IDPH Cancels Advisory Board Meeting

Other:
Member Spotlight: Riverside Senior Life Communities
Ziegler Webinar: Not-for-profit Senior Living Provider Market & Sector Update
Support the LeadingAge Illinois PAC

Top Stories:

LeadingAge Sends Letters to CMS on Testing
LeadingAge sent two letters to CMS Administrator Seema Verma this week regarding testing. The first letter makes the case for testing of hospital workers. The second letter addressed the issue of testing of state and federal surveyors.

LeadingAge Letter to CMS on Testing Hospital Workers:
Forty percent of hospital patients are over the age of 65. These individuals may be returning to a community or their homes after spending time in hospitals where hospital workers are not required to be tested for COVID-19. In some hospitals, the staff may be working on floors that without designated COVID units or designated staffing or sharing locker rooms with staff who have treated COVID-positive patients, or even working with patients who have not been tested for COVID-19 and may be asymptomatic or pre-symptomatic carriers of the virus.

LeadingAge Letter to CMS on Testing Surveyors:
Surveyors are required to be on-site in nursing homes, in close proximity to residents and staff, in resident rooms and resident areas, and observing care including COVID-19 testing. In some cases, surveyors may have greater amounts of contact with residents than certain nursing home staff who are required to be tested regularly regardless of contact. Further, these surveyors are living in communities, some of which may have county positivity rates over 5% or 10%. LeadingAge has addressed this issue with the CMS Division of Nursing Homes and the state surveyor association previously.

Surveyor testing has been a topic in our weekly meetings with the Illinois Department of Public Health (IDPH) and the Department has been meeting internally on that issue. We are told the decision will be made by the Director soon.

Cares Act Funding Distribution Update
The Illinois Department of Healthcare and Family Services (HFS) issued a notice this week as a follow up specifically for Long-Term Care (LTC) providers to the September 15 Provider Notice regarding the distribution of CARES payments related to the federal CARES Act.

The provider portal is available for online submissions. Providers that did not receive funding in the first round of the payment allocations need to apply through the portal to get funds in subsequent rounds. PBJ staffing data was worked into the methodology calculations and if there was an issue in the provider’s fourth quarter data submission, that could result in no funding in the first allocation for the provider.

There will be up to two more rounds of payments. That decision has not been made yet by the Department. The associations have requested the exact formula for how individual payments were calculated. HFS is working on releasing that information.

Provider Relief Fund Updates
On October 1, the U.S. Department of Health and Human Services (HHS) announced the next phase of funding from the Provider Relief Fund. Argentum has confirmed that assisted living providers can apply. The funding, which includes $20 billion for providers on the front lines of the pandemic, is intended to offer the opportunity for providers that have already received funding to apply for additional funding based on financial losses and changes in operating expenses as a result of COVID-19. According to HHS, it is “designed to balance an equitable payment of 2% of annual revenue from patient care for all applicants plus an add-on payment to account for revenue losses and expenses attributable to COVID-19.”

Providers can begin applying for this next phase of funding on Monday, October 5 and the deadline for applications is November 6. The portal will not open until Monday, October 5, but at that time, applications can be submitted by visiting hhs.gov/providerrelief.

If you applied for Phase 2 General Distribution (e.g. Medicaid, CHIP, Dental, private pay assisted living and nursing homes and certain Medicare providers), HHS is continuing to distribute those funds on a rolling basis. LeadingAge has heard from several members that they just recently received payments. Some assisted living members who are part of larger organizations have been told that they do not qualify for funds as their organization/Tax Identification Number has already received the full 2% of net patient revenue. This is possible especially for CCRCs/Life Plan Communities who operate under one TIN that may have already shared their tax information as part of Phase 1 and therefore received a payment equal to 2% of their net patient service revenue for their nursing home as well as their assisted living and independent living.

Nursing Home Infection Control Incentive Payments:
HHS has indicated they are aiming to begin distributing the first, roughly $400 million in payments to qualifying nursing homes around mid-October. Still no detail on the formulas being used for those Measure calculations.

New Approach to Eligible Expenses and Lost Revenues:
LeadingAge has raised concerns with HHS about the new approach to eligible expenses and lost revenues as discussed in their recent reporting guidance. LeadingAge is seeking concrete member examples of how these changes could impact members including potentially requiring some providers to be required to return provider relief payments that can’t be used because of the limits being applied to their use for lost revenues. Members with any concrete examples about how these changes may impact their ability to use the provider relief dollars can submit them to Nicole Fallon at LeadingAge.

Partners in Quality Virtual Visit Held with Office of U.S. Rep. Robin Kelly
LeadingAge Illinois and a trio of members in the 2^nd congressional district, held a Partners in Quality Virtual Visit with the Office of U.S. Rep. Robin Kelly (D-2nd District; Kankakee) this week. The zoom call educated the congressional office on the needs of members in the district and allowed members to tell their stories and urge Congress to Act for Older Adults.

Special thanks to the following members for their leadership during this visit:

Carla Brown, Market Vice President of Operations, Ascension Living.
Rick Molenhouse, Community Manager, Providence Life Services – Village Woods
Scott Studebaker, VP of Ministry Advancement & Development, Providence Life Services
Deana Wilson, Executive Director/Director of Operations, Riverside Senior Life Communities

Representative Kelly has been in U.S. Congress since 2013. She previously served in the Illinois House of Representatives at the state level. During the recent visit, each member told the story of their organization, their experiences during the COVID-19 pandemic and urged the representative to push Congress as provide additional relief funding for care and services providers and the older adults they serve.

CMS Issues Memo on Emergency Preparedness Guidance
CMS released a memo recently reiterating guidance around the emergency preparedness rule for all providers that was finalized in September, 2019. Specifically, this rule allowed an exemption from completing a full-scale or functional exercise if a provider had activated its emergency plan in response to an actual natural or man-made disaster. The memo clarifies that the COVID-19 Public Health Emergency (PHE) qualifies as a disaster and providers qualify for the exemption if they can demonstrate through written documentation that the emergency plan has been activated. Click here for a LeadingAge summary.

CMS Issues Press Release on Testing Frequency Data
CMS issued a press release recently describing updates to the methodology for determining testing frequency based on county positivity rates. The data has been adjusted to include 14 days’ worth of data, rather than the initial 7 days. Additionally, testing frequency color codes were adjusted for certain counties with low testing rates. It appears that this adjusted methodology will be used going forward. Click here for more information on this from LeadingAge. CMS on a recent call said that nursing homes can also use the adjusted color codes in determining eligibility for indoor visitation. LeadingAge Illinois will be seeking more information on this from the Illinois Department of Public Health (IDPH).

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. He announced that Region 1 will be under mitigation measures starting Saturday.

The Governor is currently working at home, quarantining, due to a staff member testing positive for COVID-19. The Governor has tested negative. It is the second time during the pandemic a staff member from the Governor’s Office has tested positive and the Governor has been quarantined.

Here is a recap of information gleaned from the briefing:

Cases:
There are over 293,274 cases and 8,672 deaths

Testing:
The state continues to test over 50,000 individuals per day. Over 5,624,822 tests have been completed.

Mitigation Measures:

Starting Saturday, October, Illinois COVID-19 Region 1 (Jo Davies, Stephenson, Winnebago, Boone, Dekalb, Carrol, Ogle, Whiteside, Lee, Crawford counties) is subject to mitigation measures (Tier 1) due to high test positivity rates in the region. Note the following points, based on IDPH’s LTC reopening guidance that took effect on August 14: Reopening Guidance.
- Any long term care facilities in Region 1 that have already advanced to CMS Phase 3 must suspend indoor visitation and off-site outings. Meanwhile, outdoor visitation may continue. Indoor visitation and off-site outings can be resumed 14 days after tiered mitigation for the region is lifted.
- Any long term care facilities in Region 1 that have not yet advanced to CMS Phase 3 are not eligible to advance to CMS Phase 3 until 14 days after tiered mitigation in the region is lifted. Specifically, that means that any plans to begin indoor visitation and off-site outings in association with phase advancement must be postponed until that time. Meanwhile, outdoor visitation may continue.
- The Illinois Department of Public Health (IDPH) will accept inquiries at ltcreopening@illinois.gov.
Region 4 (Bond, Madison, St. Clair, Clinton, Washington, Monroe, Randolph counties) remains under mitigation measures. They have been in mitigation since August 18.
Region 7 (Will and Kankakee counties) began mitigation measures on August 26.
Nine of the 11 regions have seen positivity rates decline in the last two weeks.

IDPH Files Emergency Rules for Assisted Living, Skilled Nursing and Sheltered Care
The Illinois Department of Public Health (IDPH) recently adopted emergency rules pertaining to Assisted Living, Skilled Nursing, and Sheltered Care, all effective September 15.

On-Site Inspections:
The rules reverse previous emergency rules that, in response to COVID-19, had temporarily suspended certain routine on-site visits and had dispensed with the requirement that IDPH conduct an inspection within 30 days of a complaint not related to an abuse/neglect allegation.

Transfers:
The skilled nursing emergency rules retain previous COVID-19 emergency provisions prohibiting transfer or discharge of residents for late payment or non-payment.

CNAs:
The rules repeal emergency rules that had dispensed Certified Nursing Assistants (CNAs) from the obligation to complete an IDPH-approved training program and submit required documentation within 120 days of being hired.

TNAs:
Emergency rules were filed for Long-Term Care Assistants and Aide Training Programs Code, amending a previous emergency rule for the remainder of its 150-day term. The emergency amendment terminates the Temporary Nursing Assistant (TNA) Program effective November 2. No new TNAs were to be hired after September 18. Persons currently working as TNAs may not work in that capacity after November 2, but hours worked as a TNA may be counted towards the clinical instruction requirements for CNA certification.

State LTC Ombudsman Releases Guidance on In-Person Visits
The State Long Term Care Ombudsman has released guidance on in-person visits. The Ombudsman has scheduled a webinar to review the guidance on Tuesday, October 6 at 10 a.m. You can register here.

Testing Update
We have a few updates today on testing.

Federal Announcement:
On Monday, President Trump announced the federal government would ship 150 million rapid tests to the states, indicating they would mainly be used for opening schools and ensuring safety at senior living communities. Trump added that 50 million tests will go to the “most vulnerable communities,” including nursing and assisted living communities. He stated that 6.5 million tests will be shipped this week and the rest in the weeks ahead. The rapid tests are from Abbott Laboratories.

CMS Updates COVID-19 Testing Methodology for Nursing Homes:
CMS issued a news alert on September 29 announcing an update to the methodology the agency employs to determine the rate of coronavirus disease 2019 (COVID-19) positivity in counties across the country. Click here for the announcement.

IDPH Results Reporting System:
Long-term care (LTC) facilities performing in-house antigen point-of-care testing for COVID-19 are required to report positive and negative results to public health. The Illinois Department of Public Health (IDPH) has developed a system for these facilities to report results. To assist with preparation, each facility performing in-house testing must register in this new reporting system with their CLIA certificate number and a point-of-contact email address.

For those facilities that have already started testing and are reporting positive cases to I-NEDSS or their local health department, they should continue with this process until the new system is up and running. Once the system is ready, facilities that have registered will receive a unique link to begin reporting.

The Department is also close to releasing guidance on Point-of-Care Antigen testing, including what they are looking for overall in testing requirements. The Department also informed LeadingAge Illinois that CLIA waivers apply only to specific provider addresses. IDPH will confirm if other settings on same campus can use the same CLIA waiver. IDPH reports it is not taking long to get a CLIA waiver after applying. It should only be a matter of days.

Nursing and Rehabilitation:

NHSN Security Upgrade
Have you upgraded your security level in NHSN yet? When nursing homes first began reporting to CDC through NHSN back in the spring, many opted for the expedited enrollment process that gave them access at the Level I and did not require a SAMS grid card. In late summer, CDC began encouraging nursing homes to upgrade to Level III, which requires the SAMS grid card, in order to be able to report patient-level data, such as COVID-19 test results. It is encouraged that everyone get to work on this upgrade. You can find instructions on the NHSN site here. This process will take a few weeks from start to finish. During this time, you will still have access to NHSN at Level I to continue reporting COVID-19 data per regulation.

Assisted Living:

Assisted Living Update
LeadingAge Illinois received an update from Lynda Kovarik, division chief for assisted living at the Illinois Department of Public Health (IDPH) recently on assisted living in Illinois. Lynda also was a featured speaker on Wednesday at the Senior Living Conference.

By the Numbers:

521 current assisted living establishments in Illinois.
10 establishments pending licensure.
Assisted Living Division has 9 surveyors.

Fee Increase:
Lynda has said in numerous meetings and education sessions that a licensure fee increase has been proposed by the division. It could be two to three times the current fee. Lynda said that the increase in establishments warrants extra staff and other needs, which justifies an increase in fees. The increase will need to be approved by the Governor’s Office and must go through the administrative rules process. In that process, public comment is accepted. Lynda added that the Department and all state agencies have been told by the Governor to prepare to cut their operations budgets by 5% this year and 10% next year.

Surveys:
As of August 1, IDPH surveyors have restarted annual and complaint surveys. Surveyors have PPE and were fitted with N95 masks. Surveys may take more than one day and include different surveyors. Lynda stressed that no provider will go without a license due to the backlog. For example, if your license expires on October 1, she would extend your license for 30 days.

Currently, there is no requirement for surveyors to be tested. However, there may be in the future. As we learned in our weekly meeting with Department leadership, internal discussions are ongoing with regards to testing surveyors and the Director will make a decision soon.

Rules:
As you may know, LeadingAge Illinois, Polsinelli and IDPH held several meetings to discuss proposed rule changes with the Department. Due to COVID-19, the meetings and rulemaking has been placed on hold. We will restart the conversation in 2021.

Reopening:
Assisted living is considered a congregate setting and providers should follow the mid-August reopening guidance from IDPH. In our weekly meetings with IDPH, Dr. Catherine Counard, the IDPH clinical consultant, reported that the guidance is close to being issued via SIREN. At this point, IDPH is discouraging in-person tours and encourages looking into virtual touring or other arrangements.

Update on Rapid Test Distribution and CLIA Waivers
Assisted living communities with a CLIA certificate of waiver will receive rapid point-of-care tests regardless of hotspot designation. CMS is expediting applications for those who wish to apply for a CLIA certificate and distribution allocation is based on the degree of positivity within counties. Argentum is continuing efforts to seek additional funding for the administration of tests.

Argentum recently met with HHS officials to discuss the status of distribution for the Abbott BinaxNOW COVID-19 rapid point-of-care tests to assisted living communities. HHS confirmed the purchase of 150 million rapid point-of-care tests and began distributing them to designated facilities about two weeks ago. While it is unclear how many will be/have been distributed to assisted living communities (HHS estimates 960,000 tests to 5,600 communities), Argentum reports that 50 million were earmarked for the “most vulnerable communities” including nursing homes, assisted living, HBCUs, and tribal nations. HHS plans to continue distributions through December 2020.

All assisted living communities with a CLIA certificate of waiver will receive the rapid point-of-care tests. As far as prioritization, HHS shared that the first distributions will go to all CLIA-certified assisted living communities whether or not they are in a COVID-19 hotspot (as determined by CDC epidemiological data). Currently, there are approximately 5,000 assisted living communities with such a waiver. For communities without CLIA certificates of waiver, CMS is expediting applications and communities are encouraged to apply as testing in communities will continue for some time to come. It is acceptable for a community to partner with long-term care pharmacies. The links below can provide assistance in applying for a CLIA certificate of waiver, if desired:

Similar to nursing homes, distribution is based on the degree of positivity within counties: Assisted living in areas with greater than 10% positivity (red counties) and those in areas with 5-10% positivity (yellow counties) will be prioritized. The test allocation for red counties is for testing of all staff 2x/week while the allocation for yellow counties is for testing of 50% of staff 1x/week. Once the initial round of rapid point-of-care tests has been delivered, HHS’s goal is to send tests to red and yellow COVID-19 hotspot counties only on a weekly basis. However, they indicated they may revisit this issue from time to time and send more tests to facilities in green counties (less than 5% positivity) through December.

When tests run out, HHS encourages assisted living providers to purchase additional tests on their own. As such, Argentum is continuing efforts to request additional funding support for the administration of tests. Argentum sent a letter, co-signed by the National Center for Assisted Living (NCAL), to HHS Secretary Azar, reaffirming the need for added financial support for procuring tests, acquiring requisite PPE, and effectively implementing and administering widescale testing across senior living communities.

The letter supports the methodology of providing a stipend, offering communities the appropriate reimbursement of the costs for administering tests. Argentum also reinforces the reality that while other providers may have experienced their most significant losses in the earliest days of the pandemic, the senior living industry is suffering our most significant losses now, and that they will continue to feel the pinch into the future largely due to a sharp decline in occupancy rates as a result of COVID-19.

Argentum Releases Essential Caregiver Toolkit
An Essential Caregiver program permits senior living communities, where appropriate, to allow family members, friends, or other designated individuals to have regular contact with residents where visitation may be limited as a result of COVID-19. The toolkit was developed with input from the Argentum State Partners essential caregivers taskforce, which included a representative group of our state partners and state ombudsmen. It is based on programs successfully implemented in several states (Indiana and Minnesota being primary early adopters). The document includes the model regulation for states to adopt and supplemental materials for states and communities to use in communicating the program to residents, prospective caregivers, staff, and others. It is intended to serve as a guide and is expected to be modified based on the needs of each state/community.

Independent Affordable/ Subsidized Housing:

Take the LeadingAge Affordable Housing Survey Today!
Affordable senior housing providers: we need you! To inform our housing policy work, LeadingAge is circulating a quick survey about the impacts of COVID-19 on affordable senior communities. The deadline for completing the survey is Wednesday, October 7. The survey should take about 3 minutes to complete and each question is optional. Thank you for taking a moment to complete the survey.
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HUD Issues First COVID-19 Relief Payments
Months after the COVID-19 crisis hit the United States, senior housing communities have begun receiving relief payments. HUD staff have started notifying Section 202 and other HUD-assisted housing providers of their approved COVID-19 Supplemental Payments, or CSPs. According to HUD, the agency has completed reviews of all COVID-19 Supplemental Payment (CSP) requests received in August. HUD has also obligated approved amounts to individual rental assistance contracts. The agency expects most properties to receive funds by October 7. HUD has begun providing email notifications to individual properties confirming their CSP request status. The payment mechanism is the same as standard rental assistance through LOCCs or via the contract administrator. More information from LeadingAge is available here.

LeadingAge Housing Advisory Group
On Monday, October 5 at 11:30 a.m. CST, LeadingAge will host a special edition of the Housing Advisory Group call featuring a discussion on housing provider collaborations with federally qualified health centers. Staff from the National Association of Community Health Centers will take part. Email Juliana Bilowich to join the Housing Advisory Group call, or to submit advance questions about how you can benefit from working with your area health center throughout COVID-19 and flu season. More information is available here.

Home Health and Hospice:

CMMI Announces Plan Participants for VBID
The VBID model began in January, 2017 and will be test through December, 2024. The Model is designed to test whether furnishing certain flexibilities in coverage and payment to MCOs, specifically targeted at promoting innovation, would reduce costs, increase quality, and improve coordination and efficiency of care delivery in the Medicare program. The VBID model has evolved since its initial implementation in 2017. In January 2019, for the 2020 plan year, CMS announced a number of changes including allowing MA plans to provide reduced cost sharing and additional benefits to enrollees based on chronic condition, socioeconomic status, or both, even for non-primarily health related benefits. LeadingAge has a prepared a full article outlining the VBID model.

Home and Community Based Services:

IDPH Cancels Advisory Board Meeting
The Home Health, Home Services, and Home Nursing Advisory Board meeting set for October 7 has been cancelled again. The Illinois Department of Public Health (IDPH) cites the current situation with the COVID-19 and low active board membership in order to meet a quorum to hold a Board meeting. The next scheduled meeting is tentatively set for Wednesday, January 13, 2021 from 10:30 a.m. to 12:30 p.m. via video conference centers at the IDPH offices in Springfield, Chicago, Edwardsville, and Marion.

Other:

Member Spotlight: Riverside Senior Life Communities
Riverside Senior Life Communities is part of the Riverside Healthcare Family. Their senior living options include Westwood (independent living), Butterfield (assisted living), Miller Rehabilitation, skilled nursing, estate homes and independent living, all in Kankakee. The newest community offering assisted living and memory care opened in Bourbonnais in October, 2014. The organization serves 450 older adults and has 366 employees.

One of those employees is Deana Wilson, Executive Director/Director of Operations at the senior life communities. She has served in the industry for nearly 27 years. She has been a longtime member and leader in LeadingAge Illinois. “I have been so fortunate to work most of my career for non-profit organizations who have valued the benefits of membership to LeadingAge Illinois, previously Life Services Network – that’s how long I have served in this industry,” said Deana.

She has served on a variety of committees and cabinets as well as participated in the Leadership Academy. She is currently a member of the Assisted Living Cabinet and formerly served on the Supportive Living Cabinet. She also has received Memory Support Unit Director Certification and is a Certified Marketing Professional (CMP).

Deana feels that the best part of her job is the opportunities to make a positive impact on the quality of the Riverside employees lives and help create an environment where the staff love to come to work. “I care about our staff and feel if they have their needs met and have a high level of satisfaction, this will allow them to focus on the work they love and are here to do,” said Deana. “This, in turn, reflects in the care they provide to our residents resulting in a positive impact on the residents’ health and happiness.”

She has seen both change and challenge since entering the senior living field over two decades ago, getting her start in sales and marketing. “If there is one area with the most change, it is the area of sales and marketing. Since 2000, we have moved from systems to where the only computerized platform was possibly the CRM to today complete digital platforms from marketing to move-in to electronic health record,” said Deana.

The current challenges impacting all providers is responding to the COVID-19 pandemic. In a short period of time, the industry has had to react to the dangerous virus. “Unfortunately, we have all been required to implement so many restrictions to keep our residents safe and healthy that it has resulted in the opposite – we have kept them safe from COVID, but they have lost so much due to isolation, limited social connections and lack of hugs,” said Deana. “Personally, I feel we will move past this and get back to living our best lives soon – taking with us all the many great lessons we have learned about how to have safer healthier environments for our residents.”

Deana spoke about the impact of COVID-19 on providers and residents in a recent Partners in Quality virtual visit with the office of U.S. Representative Robin Kelly (D-2^nd District; Kankakee). She urged the representative’s office to push Congress to provide relief funding specifically for aging services providers to cover additional costs for Personal Protective Equipment (PPE), cleaning supplies, staffing, and other needs associated with coronavirus.

The recent legislative meeting was another example of strong advocacy from Riverside Senior Life Communities.

Ziegler Webinar: Not-for-profit Senior Living Provider Market & Sector Update
Ziegler invites LeadingAge members to join #13 in their series of senior living & care provider webinars, October 8 at 3:30 p.m. CST. Register here. During this webinar, they will continue providing updates on current market conditions and recent senior living pricings from both the fixed-rate and bank market. Ziegler will present completed deals as well as upcoming issuances which are setting the benchmark for those accessing the markets for the remainder of 2020. Ziegler Senior Living Research will also cover updates on sector trends as well as the impact of COVID-19 on not-for-profit senior living providers. Questions can be submitted through the Q&A feature and will be addressed at the end of the discussion.

Support the LeadingAge Illinois PAC
We are now in the final quarter of 2020, one of the most challenging years the industry has had. Now more than ever we need to ensure we are a part of the discussion when lawmakers are making decisions that impact older adult care and service providers and residents/clients who depend on them.

One of the primary ways we can make sure we are a part of these discussions if through a strong 2020 LeadingAge Illinois PAC campaign. We are urging you to take part in this campaign. Like our collective voices, your contribution along with those of your fellow contributors, provides critically needed funds that assist in establishing and maintaining relationships with legislative leaders and key members of the legislature.

Special thanks to LeadingAge Illinois PAC contributors this week:

Michael Mutterer (Chair’s Circle)
Bill DeYoung
Marie Gurnik
John Larson
Dawn Zimmerman

Join the campaign by contributing today.