The Lead October 30, 2020 - LeadingAge Illinois

Life Plan Communities/CCRCs:
CCRC Cabinet Meets Virtually

Assisted Living:
Member Spotlight: Peace Village

Nursing and Rehabilitation:
ECHO Nursing Home COVID-19 Action Network
NHSN Point of Care Test Reporting Tool Webinar
Nursing Home Special Focus Facilities Legislation Introduced

Independent Affordable/Subsidized Housing:
Service Coordinator Funding Update
Affordable Housing Reception & Sessions at LeadingAge Annual Meeting

Home Health/Hospice:
Urge Congress to Support Home Health Telehealth Reimbursement
Home Health Final Rule Released
Hospice Measure Set Changes
Commonwealth Fund Home Health Brief
CMMI Webinars on Hospice VBID Model

Home and Community Based Services:
OASAC Releases Bi-Annual Report

Other:
LeadingAge/EH/VNAA 2020 Policy Accomplishments
LeadingAge/EH/VNAA 2020 Policy Accomplishments
Reinfection of the Virus that Causes COVID-19

Top Stories:

New COVID Interim Final Rule Published
A new COVID Interim Final Rule (IFR) with Comment Period was issued recently by the U.S. Departments of Health and Human Services (HHS), Treasury, and Labor. CMS has set a call on new interim final rule today from 11:30 a.m. – 12 p.m. CST. To join, call 833.614.0820 and enter conference ID 1069572. Conference lines are limited, so we encourage you to join via audio webcast.

Here is what the rule covers:

Vaccine Related Provisions. The rule implements the provisions of the CARES Act related to coverage and payment for an eventual COVID-19 vaccine. There are provisions in the rule related to Medicare, Medicaid, and private health insurance.
Updated policy for maintaining Medicaid enrollment during the COVID-19 PHE. The rule discusses how CMS is interpreting the provisions of the Families First Coronavirus Response Act (FFCRA) related to the increased FMAP and maintenance of Medicaid enrollment during the PHE.
Section 1332 waivers. This rule creates flexibilities in the public notice requirements and post-award public participation requirements for State Innovation Waivers (section 1332 waivers) during the PHE for COVID-19.
Enhanced Medicare Payments for new COVID-19 treatments. These provisions relate to how Medicare will pay inpatient and outpatient hospital settings to encourage utilization of new, approved COVID-19 treatments.
Price transparency for COVID-19 diagnostic tests. Implementation of a CARES Act provision around publicizing cash prices for COVID-19 diagnostic tests.
Extension of the Comprehensive Care for Joint Replacement model for 6 months so that the model will end on September 30, 2021.

Provider Relief Funds Update
In our provider relief update, we have information on the nursing home infection control incentives, Phase 2 assisted living payments, phase 3 applications, and more.

CARES Act Funding:
The Illinois Department of Healthcare and Family Services (HFS) would like to remind providers to apply for CARES Act funding through the HFS portal that closes October 31. See the previous provider notice for more information.

Nursing Home Infection Control Incentives for September Performance:
The U.S. Department of Health and Human Services (HHS) announced recently that the first monthly Nursing Home Infection Control Incentive Payment will be sending out $333 million to 10,501 nursing homes (76% of eligible nursing homes) who qualified for the incentive payment.

These payments should arrive on Monday, November 2. To be eligible for an Infection Control Incentive Payment, providers must first meet two “gateway” criteria:

the nursing home’s infection rate must be lower than that of the infection rate in their county;
the nursing home’s mortality rate must be less than 10% for all residents in their facility that contracted COVID-19 (includes both in-facility acquired infections as well as COVID admissions).

The incentive payments are based off performance for August 31 – September 27. There likely will be a range of payments.

Phase 2 Assisted Living Provider Relief Funds:
Assisted living communities who had their application in under Phase 2 by last Tuesday will reportedly receive a payment today. Although there has been an indication that all assisted living communities who applied for Phase 2 will have received payments as of today, that is not the sense of the senior living associations. We would like to hear if we have assisted living members did not receive payments or who are still waiting for their TINs to be validated.

Phase 3 Applications Are Low:
HHS reports that only 35,000 of a potential one million providers have applied for Phase 3 funding. Just a reminder that this round of funding is different. They’ve opened it up to any provider of health care services, and supports, including Medicare, Medicaid and private pay. Also the payments first ensure that providers get their 2 % and then any remaining funds will be distributed as add-on payments (over and above the 2%) to providers who demonstrate more need for funds to cover coronavirus expenses and lost revenues. If few providers apply, the pot of funds for add-one could be a significant portion of the $20 billion set aside for this Phase.

COVID-19 Vaccine Update
This week’s updates related to the COVID-19 vaccination includes information and updates from CMS and more.

CMS Announces Plan to Cover COVID-19 Vaccine Costs:
The Centers for Medicare & Medicaid Services (CMS) has announced a “comprehensive plan and proactive measures to remove regulatory barriers and ensure consistent coverage and payment for the administration of an eventual vaccine for millions of Americans,” including the nation’s seniors.

Pharmacy Partnership Program for Long-Term Care Deadline Extended:
The deadline for providers to opt in to the Pharmacy Partnership Program has been extended from October 30 to November 6. Providers now have an additional week to opt in and indicate pharmacy preference, either through NHSN (for nursing homes) or through the REDCap form (for all others).

LeadingAge has received answers to some questions that members have had throughout the country.

Question:
If a nursing home plans to work with its local or long term care pharmacy, does it do any harm for them to fill out the CVS/Walgreen’s application before the deadline?
Answer:
We would recommend that they fill out the form, indicate their long term care pharmacy, and then indicate CVS/Walgreens as a back-up (a back-up is required to complete the form). This way we can try to link them to their long term care pharmacy, but if their long term care pharmacy isn’t able to support (e.g., can’t handle -80 degree cold storage), we’ll be able to link them to vaccine.

Question:
Is there any guarantee that the state will allow local/long term care pharmacies to administer the vaccine? Specifically, the question from members: “I really want to use my own long term care pharmacy or local pharmacy. Is there a guarantee that my residents will be just as likely to have the same access to vaccines as if I had used the CVS/Walgreen’s partnership?”
Answer:
It really varies state-to-state. Some of the states are really backed up on-boarding providers and are prioritizing bigger hospital systems. I would suggest as above that they complete the form and indicate their preferred option and a back-up. If their long term care pharmacy is able to get vaccine through the state, then they can go that route. Many of the smaller long term care pharmacies have indicated that the -80 degree product (which has a minimum order of 1000 doses) will be very difficult for them to handle and distribute.

Question:
There is no CVS or Walgreen’s within 75 miles of my nursing home. Should I fill out the NHSN form?
Answer:
Yes, please do. We’re mapping this out and are working with a couple smaller regional chains and state health departments to ensure coverage. Just pick whichever is closer.

Affordable Housing and Pharmacy Partnership:
Affordable housing providers should see this Q&A on what the pharmacy partnership is, why such providers should fill out the REDCap form, and what this partnership might, and might not, mean for them.

TNA Program to Expire November 2
The Temporary Nurse Assistant (TNA) Program will expire on November 2. The program was initially created by rule for 150 days and extended for 45 more days when it first expired on September 18. IDPH did say that if a TNA starts a CNA training course within 45 days after September 18, they can still work in the facility. We have been discussing this issue with the Department and keep you updated.

Governor’s COVID-19 Briefings Recap
Governor Pritzker resumed his daily COVID-19 briefings at 2:30 p.m. each day this week. LeadingAge Illinois continues to monitor the briefings for information pertinent to members. “Statewide, we have a real problem on our hands and people’s lives hang in the balance,” said the Governor in his briefing opening on Thursday.

Cases:

6,363 new cases (395,458 total)
56 new deaths (9,675 total). Deaths are up 82% since October 1. The average is 41 per day.

Testing:

Over 83,000 tests in last 24 hours
About 7.5 million tests have been completed.
Averaging over 73,000 per day
Illinois is number one Midwest testing state
Cook County tests more than 37 states

Hospitalizations:

3,030 in hospital
643 in ICU
269 on ventilators
Since October began, hospitalizations have grown 73%.
ICU utilization is up 61% in October from 360 on October 1 to today’s number.
Ventilator utilization is up 61% since October 1.

Positivity Rates:

There are substantially more cases now than in the spring (up more than 150%).
Highest 7-day average was 2,565 in May. That came down to 590 in June.
Today’s 7-day positivity average is 5,043.
The positivity average is 8.2%

Mitigation:

The following Illinois COVID-19 Regions are subject to mitigation measures (Tier 1):

Region 2 (Rock Island, Henry, Bureau, Putnam, Kendall, Grundy, Mercer, Knox, Henderson, Warren, McDonough, Fulton, Stark, Marshall, Peoria, Tazwell, McLean, Woodford, Livingston, Lasalle counties) is the sole region with an average below 8% at 7.9%.
Region 3 (Hancock, Adams, Pike, Calhoun, Jersey, Greene, Scott, Brown, Schuyler, Cass, Morgan, Macoupin, Montgomery, Christian, Sangamon, Logan, Menard, Mason counties) has surpassed 8% positivity rate and is today at 8.8%. The region enters mitigation on Sunday.
Regions 4 (Bond, Madison, St. Clair, Clinton, Washington, Monroe, Randolph counties) and 10 (Cook county): Starting Wednesday, October 28.
Region 6 (Iroquois, Ford, Dewitt, Piatt, Champaign, Vermillion, Macon, Moultrie, Douglas, Edgar, Shelby, Coles, Cumberland, Clark, Fayette, Effingham, Jasper, Crawford, Clay, Richland, Lawrence counties) has had two days in a row of 8% and tomorrow could decide if they are to enter mitigation.
Region 9 (McHenry, Lake counties): Starting Saturday, October 31.
Region 11 (Chicago): Starting Friday, October 30.

Any facilities in regions under mitigation that have already advanced to CMS Phase 2 or 3 must suspend indoor visitation and off-site outings. Meanwhile, outdoor visitation may continue. Indoor visitation and off-site outings (if in Phase 3) can be resumed 14 days after tiered mitigation for the region is lifted.

Any facilities in regions under mitigation that have not yet advanced out of CMS Phase 1 are not eligible to advance to CMS Phase 2 until 14 days after tiered mitigation in the region is lifted. Specifically, that means that any plans to begin indoor visitation in association with phase advancement must be postponed until that time. Meanwhile, outdoor visitation may continue.

Testing Update
Today’s testing update includes updates on antigen testing and more.

Antigen Testing:
As part of the federal government’s shipments of Abbott BinaxNOW tests, Illinois reportedly was allotted over 3.8 million. Almost 1.4 million have been shipped to the State so far. The total national investment is $760 million. The rapid point-of-care tests can diagnose COVID in under 15 minutes. The federal government shipped over 562,000 tests directly to Illinois nursing homes and assisted living communities. Governor Pritzker has the discretion of distribution of tests sent to the State. The State has reportedly shipped almost 200,000 tests to long term care facilities.

Considerations for Use of SARS-CoV-2 Antigen Testing in Nursing Homes:
This document provides a summary of considerations for use of SARS-CoV-2 (the virus that causes COVID-19) antigen testing in nursing homes and is intended for nursing home providers and state and local public health departments.

Life Plan Communities/CCRCs:

CCRC Cabinet Meets Virtually
The LeadingAge Illinois CCRC Cabinet met via Zoom on Wednesday. CCRC Cabinet President, Colleen Bottens, executive director at Meridian Village in Glen Carbon, called the meeting to discuss member experiences during the public health emergency and receive policy updates from LeadingAge Illinois.

Issues discussed at the meeting included:

Reopening/Mitigation.
COVID-19 testing.
Staffing
Occupancy

The Cabinet is the agenda-setting body for the association on issues related to Life Plan Communities/CCRCs.

Assisted Living:

Member Spotlight: Peace Village
Peace Village in Palos Park was founded 31 years ago. The community serves 251 residents, has 200 staff and offers independent and assisted living and memory care. Diane Oremovich serves as Administrator of Assisted Living and Director of Health & Wellness at Peace Village. Her involvement in the community started as a board member, where she served six years before officially joining the organization as a staff member 14 years ago. In her time on the board, she also serves as president. A nurse, she has over 30 years of healthcare experience.

Diane has been a strong leader in LeadingAge Illinois. The board member is the President of the Assisted Living Cabinet and has been heavily involved in legislative and regulatory advocacy on behalf of assisted living members. Throughout the public health emergency, Diane has presided over frequent cabinet meetings to discuss member experiences and share best practices. In her career, she has seen the creation of assisted living and the growth since its inception. One of the biggest changes she has seen since the beginning of the assisted living option is the acuity of the assisted living resident. “Residents are trying to stay in their home longer, so they miss some opportunities associated with being able to take full advantage of the many things offered in a community setting,” said Diane.

Like all LeadingAge Illinois members, she has a passion for the industry and is a positive force in the lives of residents and staff. “Being at Peace Village, I am surrounded by a dedicated staff that treat every resident as their family member,” said Diane. “It is my privilege to be part of this team that loves all their residents.”

Nursing and Rehabilitation:

ECHO Nursing Home COVID-19 Action Network
The Project ECHO National Nursing Home COVID-19 Action Network is still actively recruiting nursing homes to join this interactive community of practice to collaboratively advance improvements in COVID-19 preparedness, safety, and infection control. Sign-up is free. Click here to find out more about ECHO Illinois. Nursing homes will be asked to participate in 16 weekly, 90-minute sessions in which they will have an opportunity to learn from subject matter experts in geriatric medicine, infectious diseases, and quality improvement. Sessions will start the week of November 9. As an added incentive for this specific program, participants can receive continuing education credits and nursing homes can receive up to $6,000 to help offset the costs of their staff participating in the training. After the 16 weeks of training, nursing homes will also have the option to receive ongoing technical assistance support from subject matter experts for another 36 weeks.

NHSN Point of Care Test Reporting Tool Webinar
The CDC has rescheduled training on the new NHSN Point of Care Test Reporting Tool for today at 1p.m. CST and Monday, November 2 at 11:30 a.m. CST. The NHSN website has not been updated yet with these new dates, but once updated you will access the registration for these webinars here under “Training”.

Also a reminder that while enforcement discretion will be exercised until November 20 on this reporting requirement, it appears that discretion will only apply to those who have been unable to report through NHSN due to a lack of Level 3 access and who have initiated the process to upgrade. Providers with Level 3 who are not reporting, or those who have not initiated the upgrade from Level 1 to Level 3 are not likely to be spared enforcement. Reporting does not stop during the upgrade process. Providers must continue reporting to the state/local health department as previously required until they are able to report through NHSN.

Nursing Home Special Focus Facilities Legislation Introduced
A bi-partisan U.S. Senate bill that moves toward significant changes in the way high performing nursing homes and Special Focus Facilities are represented in quality improvement and the Five Star program was introduced at the federal level on October 26.

This bill was developed in response to the Senate Finance hearings on the Special Focus Facility Program last year. Entitled “A bill to amend titles XVIII and XIX of the Social Security Act to modernize federal nursing home protections and to enhance care quality and transparency for nursing home residents and their families.”

S.4866:

creates an advisory council to consult with HHS on 5-Star ranking system;
revises the current system to recognize high-rated nursing homes;
expands the SFF program to include nursing homes currently on the waiting list and renames that program;
establishes an on-site consultation program to help these poor performing nursing homes improve quality and “graduate.”
allows fines collected under CMPs to be used to reinvest in poor performing homes.

LeadingAge will report on the bill in more detail as the text becomes available. They have provided comments and recommendations to the senators as the bill was being developed, including emphasizing the need for consultation and assistance for poor performers, not just penalties.

Independent Affordable/Subsidized Housing:

Service Coordinator Funding Update
On an October 26, LeadingAge hosted a call for affordable housing provider members that featured Katina Washington, acting branch chief for grants and new funding in HUD’s Office of Asset Management and Portfolio Oversight. It was the second time in recent months she joined the LeadingAge Housing Advisory Group. She gave an update on current Service Coordinator issues. Click here for more information.

Affordable Housing Reception & Sessions at LeadingAge Annual Meeting
There are several great sessions of interest to affordable housing members at the LeadingAge Annual Meeting Virtual Experience. There is also a daytime Housing Celebration Reception attendees can register for. Click here for more information.

Home Health and Hospice:

Urge Congress to Support Home Health Telehealth Reimbursement
To better protect staff and patients during the COVID-19 pandemic, home health providers have been using telehealth to deliver some services to Medicare beneficiaries. However, currently Medicare cannot reimburse home health providers for this virtual care and our home health members have been put in the position of forfeiting adequate reimbursement. Join LeadingAge TODAY in urging Congress to support home health telehealth reimbursement!

The Home Health Emergency Access to Telehealth (HEAT) Act (S.4854/H.R. 8677) supports home health providers’ ability to receive reimbursement for providing telehealth visits with appropriate protections for patients and families. The HEAT Act would put home health providers on par with all other providers with regards to flexibility during the ongoing and future public health emergencies which is critically important for the older adults and those home health providers who serve them.

Advocate for the HEAT Act by calling or emailing your lawmakers. Also, help us spread the message by forwarding this action alert to your staff, residents, and network.

Home Health Final Rule Released
CMS released the final CY2021 Home Health Prospective Payment System Rate Update rule this week.

The final rule:

Updates the payment rates for home health agencies by 2% for 2021.
Adopts the new OMB statistical area delineations while capping wage index decreases at 5% for 2021 which is consistent with CMS policy across the Medicare program.
Holds LUPA thresholds, case-mix weights, and behavior assumptions at the same levels as CY2020.
Finalizes the changes to §409.43(a) as implemented in the March 2020 IFC that states that the plan of care can and must include any provision of services furnished via telecommunications systems. The rule reiterates that visits via a telecommunications system cannot substitute for a home visit ordered as part of the plan of care and cannot count as a home visit for purposes of eligibility or payment. Send an action alert to Capitol Hill about the HEAT Act which would allow for payment for telecommunications visits during a public health emergency.
The rule also discusses the new home infusion benefit, reporting on the Home Health Value Based Purchasing Program, and changes to the Conditions of Participation OASIS requirements.

Hospice Measure Set Changes
CMS made changes to the Hospice Visits When Death Is Imminent measure set as part of the update to draft Hospice Item Set manual v.3.0. Abt Associates released a report detailing the re-specifications for the measure and the justifications for making the changes to these measures. CMS’ notification about the issuance of the report did not contain a link to the report. It can be found under “Hospice Quality Reporting Program” on the “Current Measures” page at the bottom of the page.

Commonwealth Fund Home Health Brief
The Commonwealth Fund released an issue brief on Medicare home health in the COVID-19 era. The brief is generally a useful overview. However, we want to underscore that the ability for nurse practitioners, clinical nurse specialists, and physician assistants to order home health made by the CARES Act are permanent changes to the Medicare home health benefit (the brief incorrectly refers to these changes as temporary).

CMMI Webinars on Hospice VBID Model
The Center for Medicare and Medicaid Innovation (CMMI) announced that they are holding a series of webinars and office hours on the Hospice Benefit component of the Value Based Insurance Design Model.

CMMI Webinars:

Home and Community Based Services:

OASAC Releases Bi-Annual Report
The Older Adult Services Advisory Committee (OASAC) has released their Bi-Annual Report to the Illinois General Assembly, required by law. The committee has existed for 20 years and the Illinois Department on Aging is responsible for the committee. LeadingAge Illinois representation on the committee includes Sherry Barter Hamlin, CEO of the Voyage Senior Living, John Larson, CEO of Cantata Adult Life Services and Jason Speaks of LeadingAge Illinois. The committee meets quarterly.

Other:

LeadingAge/EH/VNAA 2020 Policy Accomplishments
U.S. Congress and the Administration have heard loud and clear the advocacy voice of LeadingAge/ElevatingHome (EH) and Visiting Nurses Association of America (VNAA)! Here is a listing of policy accomplishments so far in 2020. There’s plenty more work to do and the work goes on.

Reinfection of the Virus that Causes COVID-19
Reinfection means a person was infected (got sick) once, recovered, and then later became infected again. Based on what is known from similar viruses, some reinfections are expected. The CDC is actively working to learn more about reinfection to inform public health action.