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03/25/2020

Today's COVID-19 Alert: Coronavirus Relief Bills Moving

Today's COVID-19 Alert: Coronavirus Relief Bills Moving

Here are the latest need-to-know updates for Wednesday, March 24 regarding the COVID-19 pandemic.

Please note the information related to a nursing facility focused webinar today, and an all-member call tomorrow. 

 

SNF COVID-19 Infection Prevention and Control Update - Today, Wednesday, March 25, 1:00 p.m.

Join Stephanie DeWees as she describes best practices related to nursing facility (SNF, NF, RCF and Hospice Facilities) infection control practices. Learn about the CDC guidelines and how to apply those with the challenge of limited PPE.

Join the webinar here.

For best call quality, we encourage using your computer audio.

Dial in information:

iPhone one-tap: US: +13126266799,,614534744# 

Telephone Dial-in: US: +1 312-626-6799 
Webinar ID: 614 534 744

 

All-member Call - Tomorrow, Thursday, March 26, 10:30 a.m.

LeadingAge Ohio is holding an all-member COVID-19 update call tomorrow, Thursday, March 26 at 10:30 a.m. Call in registration is as follows:

Join the call online here

For best call quality, we encourage using your computer audio.

Dial in information:

iPhone one-tap: US: +13126266799,,766248838# 

Telephone Dial-in: US: +1 312-626-6799 
Webinar ID: 766 248 838

 

Use Caution When Ordering PPE

"Gray market" PPE activity is on the rise. Members are starting to receive product availability scams for specific products that are in high demand, such as masks, gloves, and more.

Members should also be aware of cyber and phishing scams using PPE supply offers as an entry point into their networks. If a member is considering purchasing from an unknown supplier, they should remain vigilant to ensure that the products are from establishments properly registered by the FDA and that include the accompanying FDA device listing.

Members should ask for the following information from a potential supplier:

  • A copy of the Establishment Registration Number or Firm Establishment Number as assigned by the FDA.
  • A copy of the Device Listing along with the Regulation Number of the specific device.
  • Both of the above documents can be printed in PDF formant directly from the FDA’s website. Lack of this basic documentation is a red flag of potential gray market activity.

Stay alert!

 

Emergency Family and Medical Leave Act Raises Concerns

LeadingAge and LeadingAge Ohio are deep in discussions with attorneys and other experts to understand the scope of the new FMLA provisions and possible action steps to address concerns. Please send your thoughts and comments on the new provisions to kbrod@LeadingAgeOhio.org.

 

Palmetto Clarifies Hospice Visitation for NF Residents 

LeadingAge Ohio reached out to Palmetto GBA to ask how a hospice should proceed if a nursing facility has not permitted the hospice to visit the NF resident within the 15-day timeframe for the comprehensive assessment. Palmetto responded that they are awaiting CMS direction, but that “this has been a widespread problem. For now, do the best you can (phone calls, etc.) and document what happened.”

Based on this response, LeadingAge Ohio encourages hospice members to try to “visit” the patient by way of phone calls, audio/video apps, and/or close care coordination with the nursing facility staff using phone or telehealth, and document these visits, including the reasons in-person visits cannot be completed. At this time, it is not recommended to discharge these patients.  

As reported yesterday, CMS released a new QSO letter (QSO-20-20-ALL) which prioritizes surveys to only Complaint/Self-Reports triaged at an IJ level (or to clear an IJ) and Targeted Infection Control Surveys effective March 20-April 10, 2020. The letter also states that any IJ investigation will also include a review with the Focused Infection Control Survey regardless of the reason for the IJ investigation. No other surveys will be conducted during this prioritization period, and some states may not conduct focused Infection Control Surveys if their state survey agency staff have been redirected to fulfill other State Emergency Response responsibilities.

 

CMS Implements New Self-Assessment Requirement for Nursing Homes

As reported yesterday, the Centers for Medicare & Medicaid Services (CMS) announced it would be suspending all standard surveys, but would continue with complaint surveys at an immediate jeopardy (IJ) level. Surveys suspended include standard surveys for long term care facilities (nursing homes), hospitals, home health agencies (HHAs), intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and hospices. The memo clarified that the suspension includes the life safety code and Emergency Preparedness elements of those standard surveys, as well as revisits that are not associated with IJ.

The memo specifically states that if surveyors “are unable to meet the PPE expectations as outlined by the CDC guidance to safely perform an onsite survey due to a lack of appropriate PPE supplies, they are instructed to refrain from entering the provider, and obtain the information necessary remotely, to the extent possible.

Additionally, the letter also includes a new requirement for nursing homes during this period of prioritization. Based upon the Morbidity and Mortality report of the Washington state nursing home which first experienced COVID-19, CMS and the CDC are particularly focused on the extreme importance of infection control practices in nursing homes. As such, CMS expects facilities to use the COVID-19 Focused Survey for Nursing Homes as a self-assessment tool. Surveyors may request this document if an onsite investigation takes place. The Focused Survey Tool was attached to the QSO letter.

Priority areas for the self-assessment include:

  1. Standard precautions
    1. Hand hygiene
    2. Use of PPE
    3. Transmission-based precautions
  2. Resident care (including resident placement)
  3. Infection prevention and control standards, policies and procedures
  4. Infection surveillance
  5. Visitor entry (screening, restriction, education)
  6. Education, monitoring, and screening of staff

 

Senate Passes $330 Billion in Coronavirus Aid, Relief  

The bill passed yesterday by the US Senate includes $330 billion in new funding to address the needs of the American people relative to the coronavirus pandemic.

Highlights include:

  • $100 billion for a new program to provide direct aid to health care institutions on the front line of this crisis—hospitals, public entities, not-for profit entities, and Medicare and Medicaid enrolled suppliers and institutional providers—to cover costs related to this public health crisis.   
  • $16 billion to replenish the Strategic National Stockpile supplies of pharmaceuticals, personal protective equipment, and other medical supplies, which are distributed to State and local health agencies, hospitals and other healthcare entities facing shortages during emergencies.
  • $3.5 billion for BARDA to expand the production of vaccines, therapeutics, and diagnostics to help combat this pandemic.
  • At least $250 million to expand the Hospital Preparedness Program’s support of emergency preparedness, including the National Ebola and Special Pathogens Training and Education Center (NETEC), regional, State and local special pathogens treatment centers, and hospital preparedness cooperative agreements.
  • $1 billion for the Defense Production Act to bolster domestic supply chains, enabling industry to quickly ramp up production of personal protective equipment, ventilators, and other urgently needed medical supplies, and billions dollars more for federal, state, and local health agencies to purchase such equipment. 
  • $4.3 billion to support federal, state, and local public health agencies to prevent, prepare for, and respond to the coronavirus, including for the purchase of personal protective equipment; laboratory testing to detect positive cases; infection control and mitigation at the local level to prevent the spread of the virus; and other public health preparedness and response activities.
  • $200 million for CMS to assist nursing homes with infection control and support states’ efforts to prevent the spread of coronavirus in nursing homes.
  • $45 billion for FEMA’s Disaster Relief Fund to provide for the immediate needs of state, local, tribal, and territorial governments to protect citizens and help them recovery from the overwhelming effects of COVID-19.  Reimbursable activities may include medical response, personal protective equipment, National Guard deployment, coordination of logistics, safety measures, and community services nationwide
  • $200 million for CMS to assist nursing homes with infection control and support CMS and states as they work to save lives and mitigate the spread of COVID-19 in nursing homes.
  • $3.5 billion in additional funding for the Child Care Development Block Grant to provide child care assistance to health care sector employees, emergency responders, sanitation workers, and other workers deemed essential during the response to the coronavirus.
  • More than $7 billion for affordable housing and homelessness assistance programs. This funding will help low-income and working class Americans avoid evictions and minimize any impacts caused by loss of employment, and child care, or other unforeseen circumstances related to COVID-19, and support additional assistance to prevent eviction and for people experiencing homelessness.
  • $900 million for LIHEAP to help lower income households heat and cool their homes.
  • $15.85 billion for to help our nation’s veterans, including to help treat COVID-19, purchase test kits, and procure personal protective equipment for clinicians, and $590 million in dedicated funding to treat vulnerable veterans, including homeless veterans and those in VA-run nursing homes

LeadingAge is preparing a complete summary of the stimulus package, which will be included in tomorrow’s daily update

summary of the stimulus package, which will be included in tomorrow’s daily update

 

Ohio House, Senate Meeting on Coronavirus Relief

The Ohio General Assembly is working to pass a massive coronavirus relief omnibus bill. 

Ohio House session is scheduled for today, and Ohio Senate session is currently underway. House members will vote in small groups by signaling the clerk through a window, and Senators are spread out across the entire chamber. Ohio law doesn’t allow elected officials to hold meetings or vote remotely, yet.

Right now, a number of measures are being discussed, including:

  • Testing waivers;
  • Adjusting graduation requirements for high-school seniors;
  • Following the federal government’s lead in moving this year’s tax-filing deadline to July 15;
  • Changing the state’s primary election date (the Governor and Secretary of State want June 2, the legislature wants soon);
  • Pushing back Ohio’s tax-filing deadline; and
  • A number of additional coronavirus measures. 

There are also a number of more partisan issues being discussed by interested parties for inclusion in the bill, including:

  • How public corruption cases are prosecuted;
  • Legislation seeking to stop evictions and foreclosures during the coronavirus crisis;
  • Preventing utilities from shutting off service during the emergency;
  • Hand hygiene education;
  • Telehealth coverage;
  • Expanding unemployment compensation;
  • Food stamps, cash assistance, and child-care benefits;
  • Paid sick leave; and
  • Closing the health-insurance coverage gap for diagnoses.

For a bill to take effect immediately, it must include an “emergency clause,” which requires two-thirds support in each legislative chamber. So, the bill will have to be bipartisan to take effect in time to help with the crisis. That will likely require a bill which addresses some of the Democrats concerns.  

LeadingAge Ohio will continue to advocate for member concerns to the Ohio General Assembly and to the Administration.

 

Ohio Cases Climb

Director of Health Dr. Amy Acton shared updated COVID-19 numbers on Wednesday. There are 564 confirmed cases statewide, occurring in 49 counties with an age range of less than 1 to 95 years old. There have been 145 hospitalizations, with 62 now in the ICU and 25 from long-term care facilities. The state has reported 8 confirmed deaths. 

Dr. Acton shared that the state is at 60% hospital capacity after halting elective surgeries. ICU beds are at 3,600. Acton discussed the importance of  ICU bed capacity, which requires keeping individuals in the lowest-possible care settings keeping hospital occupancy as low as possible. She noted that if Ohio had done nothing to prepare, we could expect up to 6,000 new cases per day, which would completely overwhelm the state's hospitals. 

Dr. Acton recognized providers' concern on PPE, stating that ODH was distributing in boxes and cases - not by the truckload, due to limited resources. She stated that Battelle Memorial Institute and the University of Nebraska are working on new methods to re-use PPE, including UV sanitation. 

 

DeWine Calls Ohio's Efforts a "Work in Progress"

Governor DeWine echoed his awareness of the difficult situations Ohioans are in, with many out of work due to state closures. He stated the importance of “flattening the curve” so our hospital system doesn’t become overwhelmed. 

DeWine discussed some ongoing state goals, which he called a “work in progress”, including:

  • Making sure all health care workers have PPE;
  • Working to free up beds and develop capacity;
  • Improving logistics to prepare the health system; and
  • Working on COVID-19 “modeling” in partnership with the OSU Wexner Medical Center; to name a few.

DeWine was pressed on the apparent contract between his proactive approach and the President's stated desire to get back to business in 2 weeks. The Governor noted that he and the President share frustration about the situation, but  “the truth is that protecting people and protecting the economy are not mutually exclusive.”

“We save our economy by first saving lives… we have to do it in that order," stated DeWine.

 

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.

 

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Our national partner, LeadingAge, is an association of 6,000 not-for-profit organizations dedicated to expanding the world of possibilities for aging. Together, we advance policies, promote practices and conduct research that support, enable and empower people to live fully as they age.