10/26/2020

Today's COVID-19 Report: Tuesday, October 27, 2020

Tuesday, October 27, 2020

Here are the latest need-to-know updates for Tuesday, October 27 regarding the COVID-19 pandemic. 

In Today's Report

• Federal COVID-19 vaccination "Pharmacy Partnership for Long-Term Care Program" deadline Friday, October 30
• New: Twice-monthly Q&A with LeadingAge Ohio
• ODH: Survey & Cert weighs in on IJ citations for visitation
• ODH: Facilities must demonstrate crisis capacity, have policies for contact tracing
• ODH: Re-use strategies reviewed
• ECHO national nursing home COVID-19 Action Network project
• Home health teleheath bill introduced
• Weekly COVID-19 care site-specific calls
• Webinar TODAY: EVV auto-verification of visits
• Demystifying recent HHS reporting: Your questions answered webinar
• LeadingAge Need to Know

Federal COVID-19 Vaccination "Pharmacy Partnership for Long-Term Care Program" deadline Friday, October 30

The U.S. Department of Health and Human Services (HHS) and Department of Defense (DOD) have announced agreements with CVS and Walgreens to provide and administer COVID-19 vaccines to residents of long-term care facilities (LTCF) nationwide with no out-of-pocket costs. LTCF residents may be part of the prioritized groups for initial COVID-19 vaccination efforts until there are enough doses available for every American who wishes to be vaccinated. LeadingAge Ohio reached out to the Ohio Department of Health this week to better understand how this federal program will align with Ohio’s vaccination plan. Ohio Director of Health Lance Himes confirmed that ODH is encouraging providers to enroll in the federal program, while Ohio continues to refine its own plan.  

The "Pharmacy Partnership for Long-Term Care Program" provides complete management of the COVID-19 vaccination process. This means LTCF residents will be able to safely and efficiently get vaccinated once vaccines are available and recommended for them. LTCF staff who have not been previously vaccinated will also be able to get vaccinated. It will also minimize the burden on LTCF sites and jurisdictional health departments of vaccine handling, administration, and fulfilling reporting requirements.

Beginning October 19, LTCFs are being asked to enroll in the program or opt out and indicate an alternate plan for vaccinating residents. Nursing homes and skilled nursing facilities will be able to sign up via the National Healthcare Safety Network (NHSN) and all other facilities via an online sign up form. Sign up will remain open for 2 weeks.

The program is:

• Free of charge to facilities.
• Available for residents in all long-term care settings, including skilled nursing facilities (SNF), nursing homes, assisted living facilities, residential care homes, and adult family homes.
• Available to all remaining LTCF staff members who have not been previously vaccinated for COVID-19 (e.g., through satellite, temporary, or off-site clinics).
• Available in most rural areas that may not have an easily accessible pharmacy.
• HHS is using multiple authorities to ensure appropriate reimbursement for these services and that no American being vaccinated for COVID-19 will have to pay out-of-pocket.

CVS and Walgreens will schedule and coordinate on-site clinic date(s) directly with each facility. It is anticipated that three total visits over approximately two months are likely to be needed to administer both doses of vaccine (if indicated) to residents and staff. 

The pharmacies will also:

• Receive and manage vaccines and associated supplies (e.g., syringes, needles, and personal protective equipment).
• Ensure cold chain management for vaccine.
• Provide on-site administration of vaccine.
• Report required vaccination data (including who was vaccinated, with what vaccine, and where) to the state, local, or territorial, and federal public health authorities within 72 hours of administering each dose.
• Adhere to all applicable Centers for Medicare & Medicaid Services (CMS) requirements for COVID-19 testing for LTCF staff.

More information about the Pharmacy Partnership for Long-Term Care Program is linked above. If you have any questions, please contact eocevent494@cdc.gov.

New: Twice-monthly Q&A with LeadingAge Ohio

Next Thursday, November 5 at 9:30am, LeadingAge Ohio will host an all-member session focused entirely on questions and answers. During this unscripted, 30-minute webinar, LeadingAge Ohio policy and regulatory experts will field your questions related to testing, telehealth, visitation, vaccination and other fast-moving topics. Start your morning with Kathryn Brod, Anne Shelley, Stephanie DeWees and Susan Wallace, to hear Q&A on survey expectations, visitation logistics, testing processes, reporting and more.

COVID-19 has drastically reshaped the way our sector operates, with emergency rules and guidance often released mere days before becoming effective. Increasingly, aging service providers feel swamped in an “info-demic” and unsure if they’ve missed a critical new requirement. These twice-monthly Q&A webinars will be held on the first and third Thursday of the month, beginning in November to cut through the confusion and answer questions you have and those you didn’t think to ask.

Members are encouraged to swamp the COVID-19 mailbox with the questions in advance so that, if needed, research can be completed in advance. Alternately, members will be able to chat in questions during the webinar.  Registration is required, but there is no fee to participate.

ODH: Survey & Cert weighs in on IJ citations for visitation

In a weekly call with LeadingAge Ohio, Ohio Department of Health (ODH) officials confirmed that the Centers for Medicare & Medicaid Services (CMS) has become increasingly concerned about nursing home residents’ access to loved ones, and has provided state survey agencies with guidance for issuing immediate jeopardy (IJ) citations for those most egregious situations when, for example, a family is denied access to a loved one for end of life visitation. he IJ would be based on psychosocial harm and denial of the resident’s rights. CMS reiterated that visitors aren’t required to be tested for COVID-19, though certainly a nursing facility can recommend, and offer to provide testing to the visitor.

Some providers have asked whether they can require visitors to be tested, charge them for testing if completed by the long-term care facility, or charge them for masks if the facility is in crisis capacity. While ODH strongly opposed charging visitors for masks, they indicated that the other questions may be answered in forthcoming visitation guidance. They are concerned that any of these approaches may limit families’ ability to see loved ones and furthermore, in any situation where a family member would bear the expense of testing or PPE, it may exacerbate existing disparities. ODH cited the QSO memo 20-39-NH language that a nursing home must facilitate in-person visitation and the above examples could be seen as a barrier. LeadingAge Ohio continues to press the Administration for the release of visitation guidance.

ODH: Facilities must demonstrate crisis capacity, have policies for contact tracing

Ohio Department of Health (ODH) officials recently clarified what surveyors would look for when evaluating appropriate PPE use in long-term care.

Surveyors are being instructed to verify that a provider is at crisis capacity by looking in their store rooms for PPE stocks, and also by calling local health departments, emergency management agencies, sister facilities and others to verify that the provider has reached out continually in attempts to acquire PPE. This is a process that should be ongoing and continuous, not once and then completed.

ODH also noted that while contact tracing is within the purview of the local health department, all long-term care providers should have a policy on how they monitor who each staff person and resident has had contact with.

ODH:  Re-use strategies reviewed

ODH addressed the topic of re-use of N95s in today’s meeting by providing the following:

Re-use refers to the practice of using the same N95 respirator by one HCP for multiple encounters with different patients but removing it (i.e. doffing) after each encounter. This practice is often referred to as “limited reuse” because restrictions are in place to limit the number of times the same respirator is reused. It is important to consult with the respirator manufacturer regarding the maximum number of donnings or uses they recommend for the N95 respirator model. If no manufacturer guidance is available, data suggest limiting the number of reuses to no more than five uses per device to ensure an adequate safety margin. N95 and other disposable respirators should not be shared by multiple HCP. CDC has recommended guidance on implementation of limited re-use of N95 respirators in healthcare settings.

For pathogens for which contact transmission is not a concern, routine limited reuse of single-use disposable respirators has been practiced for decades. For example, for tuberculosis prevention, a respirator classified as disposable can be reused by the same provider as long as the respirator maintains its structural and functional integrity. If reuse must be implemented in times of shortages, HCP could be encouraged to reuse their N95 respirators when caring for patients with tuberculosis disease first.

Limited re-use of N95 respirators when caring for patients with COVID-19 might also become necessary. However, it is unknown what the potential contribution of contact transmission is for SARS-CoV-2, and caution should be used. Re-use should be implemented according to CDC guidance. Re-use has been recommended as an option for conserving respirators during previous respiratory pathogen outbreaks and pandemics. During times of crisis, practicing limited re-use while also implementing extended use can be considered. It may also be necessary to re-use N95 respirators when caring for patients with varicella or measles, although contact transmission poses a risk to HCP who implement this practice. Ideally, N95 respirators should not be re-used by HCP who care for patients with COVID-19 then care for other patients with varicella, measles, and tuberculosis, and vice versa.

Respirators grossly contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients should be discarded. HCP can consider using a face shield or facemask over the respirator to reduce/prevent contamination of the N95 respirator. HCP re-using an N95 respirators should use a clean pair of gloves when donning or adjusting a previously worn N95 respirator. It is important to discard gloves and perform hand hygiene after the N95 respirator is donned or adjusted.

The surfaces of a properly donned and functioning NIOSH-approved N95 respirator will become contaminated with pathogens while filtering the inhalation air of the wearer during exposures to pathogen laden aerosols. The pathogens on the filter materials of the respirator may be transferred to the wearer upon contact with the respirator during activities such as adjusting the respirator, improper doffing of the respirator, or when performing a user-seal check when redonnng a previously worn respirator. One effective strategy to mitigate the contact transfer of pathogens from the respirator to the wearer could be to issue each HCP who may be exposed to COVID-19 patients a minimum of five respirators. Each respirator will be used on a particular day and stored in a breathable paper bag until the next week. This will result in each worker requiring a minimum of five N95 respirators if they put on, take off, care for them, and store them properly each day.  This amount of time in between uses should exceed the 72 hour expected survival time for SARS-CoV2 (the virus that caused COVID-19). HCP should still treat the respirator as though it is still contaminated and follow the precautions outlined in CDC’s re-use recommendations.

Respirator manufacturers may provide guidance for respirator decontamination. At present, there are no generally approved methods for N95 and other disposable respirator decontamination prior to re-use.  Additional guidance on potential methods may be found here.

https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html

To reduce the chances of decreased protection caused by a loss of respirator functionality, respiratory protection program managers should consult with the respirator manufacturer regarding the maximum number of donnings or uses they recommend for the N95 respirator model(s) used in that facility. If no manufacturer guidance is available, preliminary data(19, 20) suggests limiting the number of reuses to no more than five uses per device to ensure an adequate safety margin. Management should consider additional training and/or reminders for users to reinforce the need for proper respirator donning techniques including inspection of the device for physical damage (e.g., Are the straps stretched out so much that they no longer provide enough tension for the respirator to seal to the face?, Is the nosepiece or other fit enhancements broken?, etc.). Healthcare facilities should provide staff clearly written procedures to:

• Follow the manufacturer’s user instructions, including conducting a user seal check.
• Follow the employer’s maximum number of donnings (or up to five if the manufacturer does not provide a recommendation) and recommended inspection procedures.
• Discard any respirator that is obviously damaged or becomes hard to breathe through.
• Pack or store respirators between uses so that they do not become damaged or deformed.

ECHO national nursing home COVID-19 Action Network project

LeadingAge Ohio has partnered with Health Services Advisory Group (HSAG) to bring the ECHO National Nursing Home COVID-19 Action Network project to Ohio. Providers who join the network by November 3 will be eligible for a $6,000 payment. This project also meets Ohio's nursing home quality initiative, that requires each licensed nursing home in the state to participate every two years in at least one quality improvement project approved by the Ohio Department of Aging. Facilities should complete the application form by November 3, 2020. Email Stephanie DeWees at sdewees@leadingageohio.org with additional questions.

Home health telehealth bill introduced

On behalf of LeadingAge, the Home Health Emergency Access to Telehealth (HEAT) Act was introduced on a bipartisan, bicameral basis by Senators Collins (R-ME) and Cardin (D-MD) and Representatives Marshall (R-KS), Sewell (D-AL), Arrington (R-TX), and Thompson (D-CA). LeadingAge and its partners, VNAA and ElevatingHOME worked very closely with the sponsors’ offices on drafting this legislation and are thrilled to see this important bill introduced.

Under current law, Medicare cannot reimburse home health agencies for delivering care through technology. Despite this significant limitation, countless home health agencies have continued to offer care via telehealth to respect the trepidation the people they serve have of allowing additional people into their home during the pandemic. The Home Health Emergency Access to Telehealth (HEAT) Act would provide home health agencies the ability to receive reimbursement for providing telehealth visits with appropriate guardrails to protect patients and families. The HEAT Act would put home health agencies on par with all other health care 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 agencies who serve them.

If you have any questions regarding the HEAT Act, please contact Anne Shelley at ashelley@leadingageohio.org.

Weekly COVID-19 care site-specific calls

The Centers for Medicare & Medicaid Services (CMS) hosts calls for certain types of organizations on an intermittent basis to provide targeted updates on the agency’s latest COVID-19 guidance. One to two leaders in the field also share best practices with their peers. There is an opportunity to ask questions of presenters if time allows.

Next Nursing Homes Call:
Wednesday, October 28,  4:30 – 5:00PM
Toll Free Attendee Dial-In: 833-614-0820;
Access Passcode: 5587022
Audio Webcast Link: https://engage.vevent.com/rt/cms2/index.jsp?seid=2627

For the most current information including call schedule changes, please click here.

Webinar TODAY: EVV auto-verification of visits

Home health agencies are encouraged to join the Ohio Department of Medicaid (ODM) at one of its upcoming webinars to learn more about auto-verification, why exceptions post to your visits, and how to achieve auto-verification of your visits. Auto-verification of visits occurs when no provider action is necessary after the visit is recorded at the time of service. All required information is captured and no exceptions are posted. Click on the date you would like to participate and you will be taken to the registration page.

              Webinar                                          Date/Time                                                 

Streamlining EVV Workflow          Tuesday, October 27, 3:30 - 4:30PM
Streamlining EVV Workflow          Tuesday, November 3, 2:30 - 3:30PM
Streamlining EVV Workflow          Friday, November 6, 10:00 - 11:00PM

Demystifying recent HHS reporting: Your questions answered webinar

You asked, CliftonLarsonAllen (CLA) listened! Please plan to join CLA for a complimentary follow up webinar on HHS reporting in which CLA experts will answer your questions from the October 8 webinar, Provider Relief Funds: Demystifying Recent HHS Reporting Curveballs, and address new questions from participants. 

For more information on this webinar and/or to register, please click here.

LeadingAge Need to Know: COVID-19 – October 27, 2020

LeadingAge shares the latest coronavirus news and resources with members twice each weekday. This morning's update featured a reminder that the Annual Meeting Virtual Experience is only two weeks away!

Check out the full report here.

Questions

Please send all questions to COVID19@leadingageohio.org. Additionally, members are encouraged to visit the LeadingAge Ohio COVID-19 Working Group facebook group to pose questions to peers and share best practices. LeadingAge is continuing its daily calls for all members.  To participate in these daily online updates, members should register here.  

LeadingAge Ohio is working to ensure that the information in our daily alerts, on our website, and all coronavirus-related communications is as accurate as possible. However, LeadingAge Ohio makes no guarantees about the accuracy of the information.