More CARES Act funding tomorrow? We hear, without official confirmation, that the Department of Health and Human Services will make "clean-up" payments out of the Provider Relief Fund under the Coronavirus Aid, Relief, and Economic Security Act overnight. Reportedly, these payments will go to Medicaid providers who do not participate in Medicare, but we do not know who is included in this rubric or how much the annointed providers will receive. There is currently better than $100 billion remaining in the fund, so more to come.

Federal COVID-19 reporting and notification requirements. We heard from members that they were unable to get into today's webinar on the new Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) reporting portal. There is another (different) training webinar tomorrow, and both today's and tomorrow's programs will be repeated next week. The NHSN COVID-19 reporting page gives considerable detail on the reporting process. According to CDC, facilities eligible to report using the new NHSN module include, "nursing homes/skilled nursing, long-term care for the developmentally disabled, and assisted living facilities."

Meanwhile, the Centers for Medicare and Medicaid Services (CMS) adopted an interim final rule codifying the reporting mandate, along with requirements for informing residents, representatives, and families of confirmed COVID-19 cases and respiratory symptoms. The rule, which takes effect upon publication in the Federal Register, sets the parameters for reporting to CDC via the NHSN. The information submitted will be posted publicly. Please note that while other facilities are eligible to report, only Medicare/Medicaid-certified SNFs are required to do so. The resident/family notification requirements also only apply to SNFs. We will provide more details about the rule in tomorrow's Update.

CMS to create Coronavirus Commission for Safety and Quality in Nursing Homes. As if that wasn't enough, CMS announced plans to appoint a commission, convening next month, to "conduct a comprehensive assessment of the nursing home response to the 2019 Novel Coronavirus (COVID-19) pandemic." As explained in CMS's release on the commission, its focus clearly will be regulatory in nature.

CMS issues another round of waivers. On a more helpful note, CMS also published updates to its catalogue of blanket waivers, this time indicating the changes in red so they are easily identifiable. For SNFs, there are new waivers relating to quality assurance and performance improvement (QAPI), nurse aide in-service education, discharge planning, providing copies of a resident's record, and several physical enviroment and Life Safety Code (LSC) requirements. See pages 16 of and 23 the compendium for more information about these waivers. Another waiver allows therapists to bill for telehealth services (page 1). SNFs are still unable to bill for telehealth, but it may be delivered in a SNF location.

There also are new waivers specifically for home health agencies and hospices (see below). The above-mentioned environmental and LSC waivers apply to multiple types of facilities, including ICFs/IID and inpatient hospices.

CMS 1135 waiver summary for HCH.

• Home health agencies:
  • Postpones the 12-hour in-service training requirement for home health aides.
  • Waives the requirement to provide detailed information regarding discharge planning.
  • Allows 10 days to provide the patient a copy of their medical record when requested.
• Hospices:
  • Postpones annual skills and competency training for hospice staff.
  • Relaxes certain physical environment regulations for inpatient hospice facilities.
• Home health and hospice:
  • Postpones the requirement for the annual onsite supervisory visit of the home health aide.
  • Narrows the scope of the QAPI program to infection control.

More on zone concept. The foundation of the state's plan for addressing COVID-19 outbreaks in congregate care settings is its regional zone concept that divides the state into regions and zones revolving around hospitals. This concept is not fully functional at the present time. OHCA previously recommended, based on what we heard from state officials, that members contact their local hospitals to request resources and assistance under the model. Today, however, we learned in a conference call with the Ohio Hospital Association that the Department of Medicaid instructed hospitals to initiate the contacts. Today's conversation focused on identifying key contact people at each hospital, developing a complete list of congregate facilities, and assigning facilities to hospitals for outreach.

CareSource administrative changes for long-term services and supports providers. In an announcement today, CareSource states that they will continue to accept requests for administrative authorizations during the COVID-19 emergency, but do not require them for the initial or annual custodial prior authorizations. Additionally, for MyCare Ohio products only, CareSource does not require a 3-day inpatient hospital stay for SNF coverage. 

CareSource also recently created an Ohio Provider Stimulus Package Program Tool to assist providers with various financial options relative to the public health emergency.

Lastly, CareSource notified providers that the Department of Medicaid asked care managers to reach out to members to discuss their current home care services and their right to implement a backup plan to decrease in-person contacts with service providers. Your clients may ask about these contacts. 

National home care study reveals instability from COVID-19. A NAHC survey of home health agencies (HHAs) nationally shows the COVID-19 pandemic severely disrupted the care delivery system, bringing significant financial pressures. Highlights from the report include:

• 41.5% of HHAs report serving active COVID-19 patients.
• 85% of HHAs report revenue reductions of 15%-20% attributed to decreased inpatient admissions and refusal of care.
• 67% of HHAs report doubling of their low-utilization payment adjustment (LUPA) cases.
• 54% of HHAs report reductions in clinical staff.

Overall, the survey strongly suggests that HHAs need financial support and Medicare policy relief to continue serving COVID-19-infected patients.

May 5 deadline for VA and SSI recipient stimulus payments. The Internal Revenue Service (IRS) issued a special alert for Supplemental Security Income (SSI) and Department of Veterans Affairs (VA) beneficiaries who didn’t file a tax return in 2018 or 2019 and have dependents to act by May 5, 2020, so they can quickly receive the full amount of their Economic Impact Payment. These individuals can use a special Non-Filers tool to receive all payments for which they are eligible at one time. For more information, please see the full notice.