COVID-19 Updates for the Week Ending April 19, 2020

What follows are the most salient COVID-19 updates for home and community-based care as of the week ending April 19. This is a weekly digest including updates already provided to home and community-based organizations via e-mail alert throughout the past week.

NY “On Pause” Extended to May 15

New York State remains “on pause,” with Governor Cuomo extending the current restrictions and closures to May 15.

The Governor on Thursday (April 16) also directed all New Yorkers to wear masks or face coverings on public transportation systems and while taking private transportation or riding in for-hire vehicles. This followed an executive order requiring all New Yorkers to wear a mask or face covering when out in public and in situations where social distancing cannot be maintained, as well as an order requiring face-coverings for all “essential business” employees (see below).

Executive Order Requiring Face Coverings for All “Essential Business” Employees

In addition to the above directives on face coverings, Executive Order No 202.16, issued last week, requires all “essential businesses” to “provide, and make available, face coverings for any employees; and employees are required to wear such face coverings when in direct contact with customers or members of the public.” The directive went into effect on April 15, at 8 p.m. and it applies to home care and other settings defined as “essential businesses” since the start of the state of emergency.

The state Department of Health (DOH) has issued a related guidance for health care settings (see here), defining “face covering” as including, but not limited to, “cloth (e.g. homemade sewn, quick cut, bandana), surgical masks, N-95 respirators, and face shields.”

By HCA’s read, this means that home care providers must coordinate: 1) the new state requirement for furnishing staff with at least cloth or surgical masks; and 2) other guidance from the U.S. Centers for Disease Control and Prevention, the Occupational Health and Safety Administration, state and local Departments of Health on use of Personal Protective Equipment (PPE), conservation and prioritization.

Our understanding is that where PPE is available and recommended, it should be used, and for all instances, providers must follow at least the levels of protection required under the Executive Order.

Another Executive Order Offering Flexibilities

Another Executive Order, issued on Friday, allows for out-of-state practitioners to provide services in New York State. The Governor’s Executive Order No. 202.18 allows physicians, nurses, physician assistants, radiologic techs, clinical nurse specialists and licensed social workers to practice in New York if they are licensed and in good standing in any other state or province in Canada. It also allows several flexibilities under the Expanded In-home Services for the Elderly Program (EISEP). Please see the EISEP section under “Current Regulatory Waivers, Changes” on our COVID-19 resource page (here).

PPE Prioritization and Distribution

HCA continued our appeals throughout the week for priority access to PPE. We joined forces with four partner groups representing long term care and managed care organizations on a letter (see here) to the Cuomo Administration calling for PPE distribution and prioritization protocols inclusive of home care. We also sought approval of recommended measures to safely provide care where PPE or staffing are insufficient, such as the enlistment of alternate care providers, voluntary plan-of-care changes, and other flexibilities.

Following HCA’s many requests for assistance, New York City Department of Health and Mental Hygiene officials also agreed this past week to reserve and initiate a limited amount of PPE that will be made available at distribution points coordinated by HCA and the New York State Association of Health Care Providers (HCP). The the distribution points are being hosted and staffed by HCA and HCP member organizations. For allocation purposes, HCA issued a survey last week to gauge provider needs based on a consensus set of distribution criteria worked out with city officials. That survey has been extended until noon today and is available here. Further instructions (distribution locations, times and procedures) are coming soon.

HCA Financial Survey

While we recognize that providers are overwhelmed by COVID-19 and have been inundated by surveys, the state Department of Health and Governor’s office have asked HCA to collect information from providers on the financial impact of COVID-19 for purposes of considering future assistance or supports. To that end, and at the state’s request, HCA last week announced a survey of the membership on COVID-19 financial issues that we ask all agencies to complete by April 23 at noon. The survey is here.

HCA, Hospital and LTC Associations Join NAHC and Organizations Across U.S. on CMS Letter Urging Regulatory Relief

The National Association for Home Care and Hospice (NAHC) has finalized a letter (see here) co-signed by HCA and organizations in almost 40 states, bringing together state home care, long term care, and hospital associations in a united front on the need for regulatory relief in home care.

Joining HCA from New York were the Greater New York Hospital Association, Healthcare Association of New York State and LeadingAge New York. HCA reported to members about the letter in last week’s Situation Report, when it was circulating in draft form. The letter, to Seema Verma, Administrator at the U.S. Centers for Medicare and Medicaid Services (CMS), urges greater flexibility on telehealth services and billing as well as the removal of signed order constraints in home care.

LHCSA COVID-19 Survey Implemented

Starting last Monday (April 13), the state Department of Health (DOH) began requiring all Licensed Home Care Services Agencies (LHCSAs) to complete a COVID-19 survey. (Certified Home Health Agencies were already required to do so.)

The survey must be completed daily Monday to Friday and is sent to the Administrator role on the Health Commerce System (HCS). HCA navigated several issues with the state’s process for alerting providers about the survey, including the non-traditional e-mail address used by the state’s third-party vendor to alert providers. This caused various issues; for one, the state’s alerts to providers were either unreceived or the domain names were unrecognized by end users rightly concerned about cybersecurity.

Reporting COVID-19 Related Deaths to NYC Using eVital

The New York City Department of Health and Mental Hygiene issued an April 11 “Health Alert on Face Mask Use Policy, Swab Shortage, Reporting COVID-19 Related Deaths and Crisis Communication Resources.” According to the alert here, “all deaths that occur in NYC, including any death possibly related to COVID-19, must be reported to the NYC Health Department through the online system known as eVital.” Only authorized users can enter data or report deaths using eVital. Health care facilities that are not authorized to use eVital can e-mail for permission to report deaths. Deaths should not be reported via telephone to the NYC Health Department.

OSHA Issues Good-Faith Compliance Guidance

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has issued interim guidance (see here) to advise compliance safety and health officers to “evaluate an employer’s good-faith efforts to comply with safety and health standards during the coronavirus pandemic.” Employers unable to comply with OSHA requirements because local authorities required the workplace to close “should demonstrate a good-faith attempt to meet applicable requirements as soon as possible following the re-opening of the workplace.” Also, OSHA will take employers’ attempts to comply in good faith into strong consideration when determining whether it cites a violation.

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