The Lead October 16, 2020 - LeadingAge Illinois

Nursing and Rehabilitation:
Project ECHO Update

Supportive Living:
Supportive Living Rates

Independent Affordable/Subsidized Housing:
LeadingAge Illinois HUD Member Regional Monthly Meeting Recap
HUD Postpones CAN e-Tool Launch

Home Health and Hospice:
Technical Guidance for VBID Hospice Benefit
Quality Reporting for Hospices
Hospice Guidance on Contracting for Core Services

Other:
Member Spotlight: Norwood Life Society
Social Security Administration Announces 2021 Increase
U.S. Department of Labor Issues Interim Final Rule Dramatically Increasing the Prevailing Wage
Streamlined forgiveness for Small PPP Loans
Illinois First in Nation to Provide Healthcare Benefits to Noncitizen Seniors
State Plan on Aging FY2021-FY2023
IRS Extends Non-Filer EIP Deadline Until November 21
Telehealth Update
Strategies for Optimizing the Supply of Isolation Gowns

Top Stories:

IDPH/HFS Weekly Meeting Recap
Each week, LeadingAge Illinois and the associations meets with leadership from the Illinois Department of Public Health (IDPH) and the Illinois Department of Healthcare and Family Services (HFS) on COVID-19 issues.

Dr. Catherine Counard, Medical Officer for the Office of Health Protection at IDPH opened Thursday’s meeting by thanking the associations and providers for their work during the pandemic. “I am appreciative of everyone’s work on what we are accomplishing together. The number of cases is increasing, but we are still seeing a steady decrease in long term care across the board,” said Dr. Counard. “We are working through the difficult challenges together. I really think we should take a moment to say we have made a lot of progress. We should stay the course and we are working very hard and well together. I think it is a success story. The control measures in place are working.”

Counard said that there were 176 new cases in all types of long term care last week. It is the lowest since March. Most of the overall COVID deaths are persons over age 60, but only 22% of that is in long term care. The majority of the deaths are in the general community.

Surveyor Testing:
IDPH is in the final stages of working out the logistics of creating a policy and procedures on testing for surveyors. The final decisions and approvals will be made by the IDPH Director. IDPH reported that all surveyors have been trained on proper PPE usage, social distancing, minimizing time in facilities and all have been fitted with masks.

CARES Act Payments:
HFS reported that if a provider does not get the budget in on time, they will not be eligible for round two payments.

CMP Allocations:
LeadingAge Illinois has been vocal for several weeks on CMP funding. The federal government has allowed CMP funds to be utilized for communicative technologies as well as equipment for visitation, etc. IDPH, however, is still working out details on CMP funds internally and discussing the funds with CMS.

Reopening Guidance:
The new reopening guidance is in final draft form from IDPH, but has still yet to be approved by the Governor’s office.

POC Testing Portal:
For the IDPH point-of-care testing portal, if a facility needs to change/update their testing system or other information that is prepopulated, they should contact IDPH via email.

TNA Program:
IDPH recently adopted an emergency amendment to Long-Term Care Assistants and Aide Training Programs Code, effective September 25 through November 2, replacing a previous emergency rule and emergency amendment to emergency rule that both expired on September 17. This new emergency rule terminates the Temporary Nursing Assistant (TNA) Program effective November 2. No new TNAs were to be hired after September 18, as we noted in previous newsletters.

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. IDPH reported that they are having internal discussions on extending the program beyond November 2 and will have progress updates in the weekly meetings.

Provider Relief Fund Update
LeadingAge recently prepared an article covering the changes on the interpretation of “hiring” for the purposes of eligible expenses under the Nursing Home Infection Control Distribution and covering additional information that HHS has posted regarding the Phase 3 General Distribution application process. As part of the article and listed separately on the LeadingAge COVID-19 page, LeadingAge has a table that summarizes the distributions to aging services providers from the Provider Relief Fund to date in an effort to help track the allowable purposes for each set of funds received.

Provider Relief Fund Nursing Home Infection Control Incentive Payments:
HHS announced that their calculations for September show that 65-70% of nursing homes will qualify for a Nursing Home Infection control Incentive Payment to be issued by the end of this month. LeadingAge met with HHS Secretary’s office staff this week to discuss developments on the Nursing Home Infection Control incentive payments. The main focus of the changes focus on the mortality measure calculation and its use to determine final incentive payments. Originally, it appeared that HHS would set aside 20% of the $400 million monthly to provide incentive payments based upon nursing homes’ performance on a mortality measure.

The disadvantage of this approach is providers with no infections and therefore no deaths from infection (a good thing) would not have been eligible for these funds. HHS explained that instead of setting aside those payments, it will first determine which nursing homes meet the gateway criteria on infection rate and mortality. Then it will calculate a total infection control score which will be made up of the infection rate measure performance score modified based upon mortality performance, as applicable. The adjustment to the overall score will be no more/less than 20% for mortality.

HHS noted that nursing homes have already shown a 5% improvement on infection control between August and September. In addition, only 127 homes did not pass the mortality gateway, while 122 others who had deaths in their facilities will still qualify for an incentive payment once they complete their outreach to determine which COVID deaths were from infections obtained from within the nursing home versus those who were admitted with COVID.

HHS could not yet provide information on the range of incentive payments but should have this information in the next few days with payments possibly beginning on the week of October 27. In addition, we did advocate for more information to be made available so members can calculate or at least better understand what data is being used to calculate these incentive payments. HHS appeared willing to provide some more information and agreed to check on the legal limits they may have in publishing information on which nursing homes received incentive payments and the amounts.

CMS Confirming CLIA Certifications
CMS is taking every action to ensure U.S. laboratories are fit to deliver reliable, accurate and timely patient test results for COVID-19 by confirming Clinical Laboratory Improvement Amendments of 1988 (CLIA) certifications are up- to-date. A recent record check by CMS resulted in the issuance of 171 cease and desist letters to facilities that did not have proper CLIA certifications in place. CLIA certification is important because it verifies that laboratories meet federal performance, quality and safety standards to properly diagnose, prevent and treat diseases.

CDC Diagnostic Test for COVID-19 Only and Supplies
The CDC updated information regarding CDC’s diagnostic test for COVID-19 and the supplies needed to do the test. Click here for more information from the CDC.

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’s briefing included updates on testing and the 11 COVID-19 Regions.

Cases:
There are over 327,605 total cases in Illinois with over 9,075 deaths.

Hospitalizations:
As of the press conference, there were 1,974 in the hospital with COVID-19, with 390 in the ICU and 153 on ventilators.

Testing:
There have been over 6,463,923 total tests completed. The State is averaging over 60,000 tests per day (more than 3 times as much as other states). Tests are reportedly being returned within an actionable period of time.

IDPH began reporting on their website both molecular and antigen test results. Neither are antibody tests. IDPH will be redoing the way they calculate Region 6 (Champaign, Clark, Clay, Coles, Crawford, Cumberland, De Witt, Douglas, Edgar, Effingham, Fayette, Ford, Iroquois, Jasper, Lawrence, Macon, Moultrie, Piatt, Richland, Shelby, Vermillion counties) to more accurately represent the spread across the region. They will remove the University of Illinois saliva testing to separate those tests out.

Regions:

All 11 regions have seen an increase in their positivity rates compared to last week.
The state positivity rate is more than 1% in the last week.
Most regions have seen hospital admissions due to COVID increase.
Region 1 (Boone, Carroll, DeKalb, Jo Daviess, Lee, Ogle, Stephenson, Whiteside, Winnebago counties) entered tightened mitigation on October 3 and continued to see positivity rates climb. They are now at 10.1% with hospital admissions stabilized after two weeks of growth.
Region 5 (Alexander, Edwards, Franklin, Gallatin, Hamilton, Hardin, Jackson, Jefferson, Johnson, Marion, Massac, Perry, Pope, Pulaski, Saline, Union, Wabash, Wayne, White, Williamson counties) had surpassed 8% positivity rate, up from 5.8% two weeks ago. At the press briefing time, it was down to 7.7%. If it gets above 8% again, the region will face stricter mitigations.

Respiratory Protection Program
On the October 15 webinar from the Illinois Department of Public Health (IDPH), the Respiratory Protection Program for Congregate Care Facilities was outlined. Click here for the document titled Compliance with OSHA’s Respiratory Protection Standard from the Illinois Department of Labor (DOL).

CMS released guidance relevant to this on August 26. For more program information contact the Illinois DOL at 1.800.972.4216.

Nursing and Rehabilitation:

Project ECHO Update
We have some updated information to provide on the Project ECHO National Nursing Home Action Network.

Supportive Living:

Supportive Living Rates
The Illinois Department of Healthcare and Family Services (HFS) recently released the updated Supportive Living Program (SLP) Rates. They are effective October 1. Click here to see the rates.

Independent Affordable/Subsidized Housing:

LeadingAge Illinois HUD Member Regional Monthly Meeting Recap
On Thursday, LeadingAge Illinois hosted the monthly HUD Member Regional Meeting. The meeting, held via Zoom, is held every third Thursday at 12 p.m. CST. The meetings feature updates from Linda Couch, Vice President of Housing Policy and Juliana Bilowich, Director of Housing Operations at LeadingAge National. Members and staff from LeadingAge Illinois, LeadingAge Indiana, LeadingAge Minnesota and LeadingAge Missouri take part in the monthly meetings.

Here is a recap of this month’s meeting:

Congressional Meetings:
LeadingAge Illinois held another round of virtual Partners in Quality visits with members and federal legislators since the last meeting. The meetings focused on the LeadingAge $1.2 billion senior housing ask and were with U.S. Representatives Danny Davis (D-7th District; Chicago), Robin Kelly (D-2nd District; Kankakee), Bobby Rush (D-1st District; Chicago), and Representative Sean Casten (D-6th District). LeadingAge Missouri reported that there will be new member of the Missouri delegation after the election and plans are underway to meet with the new legislator.

Relief Funding:
The U.S. House passed another COVID-19 Relief package multiple times, but the Senate has not taken up the bills. The passed package included funds for service coordinators. The House has since left D.C. and the Senate is in, but primarily focused on the confirmation of a new U.S. Supreme Court pick. LeadingAge is still pushing for action before the election.

Continuing Resolution:
October 1 began the new federal fiscal year. The 12 annual appropriations bills have not been passed and Congress has passed a Continuing Resolution that keeps HUD programs funded through December 11. The 40 IWISH demonstration program sites that sunset September 30 continue under the resolution. LeadingAge is pushing for a two-year extension and HUD supports the extension.

COVID-19 Testing and Flu Vaccinations:
Members discussed using housing sites for testing for COVID-19 and for flu vaccinations. Providers seeking to conduct testing onsite must have a CLIA waiver.

COVID-19 Supplemental Payments:
Some members reported that they have received their supplemental payments for both tier one and two. A second round of payments is anticipated. The first round was for the end of March through the end of July. The second will mirror the first allocations and be for August through December. An official announcement is coming this fall. LeadingAge provided HUD feedback on what they would like to see in another application round, such as more time to apply, etc.

HUD Multifamily FAQs:
HUD released new FAQs on October 14 which have some updated items such as evictions, COVID-19 testing and flu shots onsite, REAC inspections, financial statements, etc.

Housing Advisory Committee:
On October 26, HUD staff will join the LeadingAge Housing Advisory Committee call at 11:30 a.m. CST to present on topics such as service coordinator payments, delays on extensions and standards for success reporting. To receive dial-in information, contact Juliana Bilowich.

HUD Postpones CAN e-Tool Launch
HUD has postponed the launch for version 3.0 of the Capital Needs Assessment (CNA) e-Tool until November 9. Originally slated for October 13, the CNA e-Tool team observed issues with the tool during final confirmation testing and will release a fix prior to the launch. The data transfer period has been extended to November 6.

Ahead of the launch of the web-based CNA e-Tool, HUD reminds providers to do the following:

Obtain access, to enable you to access the CNA e-Tool with your M-ID
Attend the Getting Started and User Basics webinars or viewed the archived versions (available on the CNA e-Tool Webpage or on the HUD Exchange)
Validate any unfinished Assessment Tool file in the Submission Portal before the Data Transfer Period ends on October 9th at 11:59 pm Eastern Time.
Please see the flowing tutorial for directions on how to complete data transfer. Also here are answers to FAQs on data transfer.

When the new system is LIVE, HUD will send out an announcement email to all users. For further technical information, please email HUD.

Home Health and Hospice:

Technical Guidance for VBID Hospice Benefit
CMMI released the technical and operational guidance for the VBID Hospice Benefit Component for CY2021. Click here to view the guidance.

Quality Reporting for Hospices
The draft Hospice Item Set (HIS) Manual V3.0 is now available and will be effective January 1, 2021. Please note the HIS Manual is not yet final. Office of Management and Budget (OMB) approval is required, and expected later this year. Once approved by OMB, the draft will be final.

Hospice Guidance on Contracting for Core Services
On October 5, the Centers for Medicare & Medicaid Services (CMS) issued memorandum QSO-21-01 Hospice– “Nursing Shortage as an ‘Extraordinary Circumstance’ per 42 CFR 418.64 CORE SERVICES” to State Survey Agency Directors. CMS has issued memoranda authorizing use of contracted staff under extraordinary or other non-routine circumstances as authorized under the “extraordinary circumstances” core services provisions at 42 CFR 418.64 on a regular basis over recent years based on the ongoing nursing shortage. The most recent memo, issued in 2018, was applicable through September 30, 2020. The October 5 memo does not have an expiration date for the authority and does not explicitly limit the use of contract staff to nursing so could be used, when applicable, for counseling and social work staff as well as long as the other requirements of the guidance are met.

Other:

Member Spotlight: Norwood Life Society
Norwood Life Society is almost 125 years old. Founded in 1896 as the Norwegian Old People’s Home Society, the organization was founded to govern the operation of a standalone not-for-profit retirement home on the Northwest side of Chicago.

Today, the organization does more than operate just the one senior living community (now known as Norwood Crossing). They also operate a second community (Bethesda Rehab & Senior Care), a home and community based services company (Norwood Seniors Network), a 500 member strong senior volunteerism program (norVOLution), has a contract with the City of Chicago to operate one of their Senior Centers, and operates the Norwood Life Care Foundation to support the charitable missions of these endeavors.

The organization has grown considerably over the years. They typically have around 360 residents at the two communities on any given day, around 200 home care and meals clients in the community, and 150 visitors to their senior center daily, plus the volunteers for the community work. Over the course of a year, the organization usually helps 2,000 – 2,500 different seniors. They have over 450 employees.

Michael Toohey, CEO/President of Norwood Life Society, has been in health care since 1983 and senior living specifically since 1989. He has been very active in LeadingAge Illinois, serving previously on the Nursing Facilities Cabinet and the Home and Community-Based Services (HCBS) Cabinet. “Getting involved in these cabinets and committees is a wonderful experience that I would highly recommend,” said Michael. “The same is true for hosting legislative visits – just do it.”

Michael has hosted his legislators annually and also recently led a Partners in Quality virtual visit with U.S. Representative Jesús García (D-4^th District; Chicago), where he and Silvia Morici, COO of Norwood urged the representative to push Congress to pass another COVID-19 relief package. Michael has also been instrumental in helping with previous LeadingAge Illinois annual meetings, serving on a session selection committee.

Michael enjoys alot of things about his job, the industry, and Norwood. “While it is hard to pick out a best part, I would say that it is working with smart, compassionate, dedicated, nice people,” said Michael. He enjoys seeing team members learn their craft, develop as leaders, grow into and out of roles and make their mark in the industry. “Ours is an industry always in need of talent, at all levels, and seeing these folks develop is really gratifying,” said Michael.

In over 30 years working in senior living, Michael has had the opportunity to see his organization as well as the industry change and make way for excellence in older adult care and services. “It is gratifying to see the entire culture of senior living constantly evolving for the better. The medical models have given way to so many wonderful ideas and concepts, which have spurred development of nicer and more thoughtful campuses and buildings,” said Michael. “The biggest change is the concept of continuously raising the bar for excellence, which benefits the whole society.”

Social Security Administration Announces 2021 Increase
The U.S. Social Security Administration announced a 1.3% increase to Social Security and Supplemental Security Income (SSI) for 2021. The cost-of-living adjustment, or COLA, impacts roughly 70 million Americans; the modest increase translates to about $20 more per month for the average retiree and represents the smallest annual increase since 2017. Social Security and SSI beneficiaries are normally notified by mail starting in early December about their new benefit amount.

U.S. Department of Labor Issues Interim Final Rule Dramatically Increasing the Prevailing Wage
The U.S. Department of Labor (DOL) published an interim final rule that changes how prevailing wages are calculated, which has an immediate impact on foreign workers in the H1B, H1B1, and E-3 programs. Although an interim final rule, the rule went into effect immediately. This has a big impact on the wages paid to foreign workers and for our members it primarily concerns nurses brought in by long-term care providers to address workforce challenges.

Streamlined forgiveness for Small PPP Loans
The U.S. Treasury and U.S. Small Business Administration (SBA) announced a new forgiveness application for PPP loans of $50,000 or smaller- the smallest of the PPP loans. Under this new application, borrowers will need to certify that they used their loan funds in compliance with federal law and regulation but do not need to submit detailed data on how the loan funds were used. Loans of larger amounts still need to be processed through the regular or EZ application forms, both of which require reporting of how loan funds were used.

Illinois First in Nation to Provide Healthcare Benefits to Noncitizen Seniors
In December, Illinois will become the first state in the country to provide healthcare benefits to seniors ages 65 and older regardless of immigration status. The funding for the program was approved last spring. Full benefits and program rules should be completed this month. It will be about a $5 million program for below the poverty line seniors. Although the program goes live in December, program enrollees can have retroactive coverage to pay for medical bills from the past year.

State Plan on Aging FY2021-FY2023
The Illinois Department on Aging (DoA) has drafted the State Plan on Aging for FY2021-FY2023. Stakeholder Hearings have been set for October 19, 22 and 29. Register here.

IRS Extends Non-Filer EIP Deadline Until November 21
For the last time, according to the IRS, it has extended the deadline for non-filers to register to receive Economic Impact Payments from the IRS. Millions of non-filers were left out of receiving these stimulus checks but are nonetheless eligible for them, but they must register to do so by November 21.

Telehealth Update
We have a couple updates today on telehealth, both from the state and federal levels.

On October 14, CMS expanded the list of telehealth services that Medicare Fee-for-Service will pay for during the COVID-19 Public Health Emergency (PHE). These new telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services. The list of these newly added services is available on the List of Telehealth Services webpage.

CMS also released a new supplement to its State Medicaid & CHIP Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, COVID-19 Version that provides numerous new examples and insights into lessons learned from states that implemented telehealth changes.

The updated supplemental information is intended to help states strategically think through how they explain and clarify to providers and other stakeholders which policies are temporary or permanent. It also helps states identify services that can be accessed through telehealth, which providers may deliver those services, the ways providers may use in order to deliver services through telehealth, as well as the circumstances under which telehealth can be reimbursed once the PHE expires. They also released a preliminary data snapshot on Medicaid and CHIP telehealth utilization during the pandemic.

At the State level, LeadingAge Illinois has joined a coalition of state healthcare organizations to urge the Illinois General Assembly to make payment parity for telehealth services permanent. It could spearhead widespread telehealth adoption moving forward. The coalition includes AARP Illinois, the American Nurses Association-Illinois and Illinois Society for Advanced Practice Nursing, the Association of Community Mental Health Authorities of Illinois, the Health Care Council of Illinois, the Illinois Association for Behavioral Health, the Illinois Critical Access Hospital Network, the Illinois Health and Hospital Association, the Illinois Health Care Association, the Illinois Occupational Therapy Association, the Illinois Primary Health Care Association, the Illinois Psychiatric Society, the Illinois State Medical Society, and the Kennedy Forum.

Strategies for Optimizing the Supply of Isolation Gowns
This CDC document offers a series of strategies or options to optimize supplies of isolation gowns in healthcare settings when there is limited supply. It does not address other aspects of pandemic planning; for those, healthcare facilities can refer to COVID-19 preparedness tools.