What follows are the most salient COVID-19 updates for HCA members as of the week ending May 10.
This is a weekly digest of new information as well as briefs that may have already been provided to home and community-based organizations via e-mail alert throughout the past week.
“Reopening” and “Reimagining”
Two major themes arose from Governor Cuomo’s press briefings on the COVID-19 crisis this week: “reopening” and “reimagining.”
First, the Governor laid out a staged, region-based plan for “reopening” New York from its current state of economic and societal “pause” due to the COVID-19 medical emergency.
The Governor announced over the weekend an extension of his legal authority to continue the state’s “pause” for now — along with its associated directives for social distancing, closures and precautions — though the “on pause” deadline end date officially still remains May 15 as of press time for the Situation Report. (Press reports suggesting an extension of the “on pause” deadline prompted a clarifying statement from Secretary to the Governor Melissa DeRosa.)
Secondly, the Governor announced that he is tapping the Bill Gates Foundation and former Google CEO Eric Schmidt on a commission to “reimagine” New York with a focus on issues such as telehealth, remote learning and broadband access — an effort to improve the kinds of public services proven vulnerable during the pandemic. This “reimagine” effort will also include Northwell Health CEO Michael Dowling who is tasked with improving health services, although specific details of those goals or focus areas are unknown at this time.
The Governor’s reopening plan hinges on a number of criteria: a slow-down in net and new hospitalizations; a hospital bed vacancy of 30 percent; the deployment of at least 30 contact tracers per 100,000 individuals (contact tracing is a process that involves the identification of persons who may have come into contact with an infected person); and a weekly average of 30 virus tests per 1,000 residents a month, among other stipulations.
Related to this effort, HCA announced to members last week a grant we were awarded from the Mother Cabrini Foundation to train up to 18,000 home care professionals on how to conduct COVID-19 testing in the home care environment. We see this home care testing initiative as fundamental to the stated criteria of the Governor’s reopening plan — with its emphasis on testing and infection surveillance — especially in light of Cuomo Administration survey data, also announced this week, showing that 66 percent of people who are admitted to the hospital with COVID-19 are admitted from their homes.
We look forward to announcing further details on the rollout of this exciting initiative.
Elective Procedures Allowed in Some Counties
In another significant pivot toward reopening, the Governor also announced this past week that hospitals in approximately 35 counties — as well as institutions in other counties who are granted a waiver — can begin resuming elective procedures, many of which may result in a rebound of post-acute care referrals to home care settings.
As Congress gears for yet another possible COVID-19 aid package, HCA is working with the National Association for Home Care and Hospice (NAHC), individual members, and affiliate organizations to redouble our federal advocacy efforts aimed at key supports for home care and hospice.
This effort would seek to build much further on the thus-far limited federal funds made available to community-based providers alongside recent regulatory flexibilities, like the newly expanded authorization for non-physician practitioners to order and certify home health services.
Prominent among these outstanding needs are considerable financial support to stabilize home and community-based providers as well as meaningful telehealth flexibility under Medicare, which is the theme of an op-ed by HCA President Al Cardillo that was published Sunday in the Empire Report. (See the article here: “In COVID-19 Fight, Essential Home Care Needs Essential Supports from Congress”).
Please also read the related story in this week’s Situation Report on our federal advocacy strategy here, as well as an article with new information from the U.S. Centers for Medicare and Medicaid Services (CMS) regarding billing codes for NPP ordering of home care.
New FAQs on CARES Act Funds
The U.S. Department of Health and Human Services (HHS) has updated its FAQs on CARES Act provider relief fund distributions.
Medicare providers who have already received a payment from the Provider Relief Fund are now eligible to apply for additional funds by submitting data about their annual revenues and estimated COVID-related losses via the Provider Relief Fund Application Portal here.
Also, some newly updated FAQs (added May 6) address the return of funds in the event that a provider receives a payment greater than expected or a payment in error. They also address whether HHS intends to recoup funds if certain requirements aren’t met, such as a provider being unable to demonstrate that lost revenues and increased expenses exceed payments from the relief fund. In such cases, HHS says it reserves the right to audit and collect.
Discontinued: Expanded Timeframe for Home Care Registry Submissions and Recordkeeping Immunity
As announced in a May 8 alert to the membership, the Cuomo Administration (under Executive Order No. 202.28) has discontinued the extended timeframe for a home care organization to submit information to the state’s Home Care Registry, reverting back to requirements that were in effect prior to the state of emergency. (Under a prior Executive Order and follow-up state Department of Health (DOH) guidance, the timeframe was extended for 60 days.)
HCA is seeking to determine why the Executive chose this particular regulatory modification (among others) to discontinue at this time, especially with the persistent need for relief from procedures or administrative tasks of a non-direct-care nature. HCA continues to press for regulatory waivers at all levels, state and federal, to provide vital relief for providers amid the overwhelming demands of COVID-19 home care delivery and response.
Since Friday’s alert, HCA has identified another statutory modification that has also reverted to prior standards. The Administration is also discontinuing relief to health care providers on record-keeping requirements, including immunity protections. (The original executive order granting the record-keeping relief stated that “any person acting reasonably and in good faith under this provision shall be afforded absolute immunity from liability for any failure to comply with any record-keeping requirement.”)
HCA is seeking to determine if there are any additional temporary regulatory modifications affecting home and community-based care, like the above, that may have otherwise also expired or been discontinued.
DOH Announces Changes to Daily CHHA, Hospice Surveys
DOH told HCA over the weekend that it will be announcing changes to the COVID-19 surveys that are required daily of Certified Home Health Agencies and hospices.
Additional answers will be requested, including whether or not an order has been placed for personal protective equipment (PPE) and the expected amount of PPE as well as the calculated days of each type of PPE remaining.
DOH says the purpose of this change is to better align the results with survey questions for nursing homes and adult care facilities “for purposes of preparing PPE shipments.” The surveys will also be asking for contact information for the person who is reachable 24/7 and a cell phone number.
Agencies are instructed to not report inventory of PPE that they do not use for COVID-19 positive patients (e.g., coveralls). For obtaining an accurate daily count, DOH advises agencies that, as admissions change, the numbers should as well. Agencies with questions regarding their reporting should send an e-mail with a contact and phone number to: firstname.lastname@example.org.
Agencies are also reminded to update their 24/7 contacts in the Health Commerce System and include cell phones where staff may be reached.
HCA understands that these surveys place enormous time and administrative demands on providers and we are seeking to learn more about what DOH intends to do with the information being collected.
We are also seeking to obtain at least some of the data from DOH for our own analysis. Receiving this data will help preclude HCA from having to make duplicative survey requests of members — who are already being surveyed by DOH — in our effort to assess systemwide needs and experiences related to the medical emergency.
LHCSA Data Validation
DOH also announced over the weekend that it will begin a LHCSA data validation process starting on Monday with calls placed to LHCSAs during the business day. DOH is seeking to confirm the number of aides employed at the end of January as well as the total number of home care aide hours in January in order to gain a sense of the loss of hours and workers in April and May. It appears that some of the data for January may have some discrepancies and DOH is seeking to learn if agencies were reporting data consistent with what DOH intended.
DOH said it will call the LHCSA and read the reported data for a specific day of the month. The data will not be changed retrospectively during this confirmation process, but DOH will monitor changes in the numbers going forward for those LHCSAs that could not confirm their data.
DOH Infection Control Surveys Continue
DOH is continuing its infection control surveys and is planning to survey some upstate providers.
As mentioned in last week’s edition of the Situation Report, DOH started conducting focused off-site surveys of some downstate Certified Home Health Agencies and Licensed Home Care Services Agencies related to COVID-19 infection control policies and procedures. DOH first sends an e-mail to the agency’s Administrator and Director of Patient Services about the survey and then follows up with a phone call.
The agencies are asked to submit certain documentation related to COVID-19 policies within four hours, and DOH includes a list of relevant guidance that it has issued. Agencies unable to return the documents in the time allotted should contact the regional office staff surveying the agency.
DOH has indicated the focused surveys are primarily educational in nature, bringing attention to a review of infection control practice and guidance that has been issued.
PPE for NYC Home Care Providers
HCA reminds members serving New York City that they are eligible to obtain limited amounts of personal protective equipment (PPE) from a stockpile made available via the NYC Department of Health and Mental Hygiene (DOHMH).
HCA and the New York State Association of Health Care Providers (HCP) have set up distribution sites run by our members and have distributed PPE in three phases, including face masks, gloves and face shields. This will continue as long as NYC DOHMH makes the supplies available.
If you have not picked up PPE from any of the distribution sites, contact Lauren Ford at email@example.com.
Statewide Survey Results Probe Unmet PPE Needs on a County Basis
Associations representing long term care, including HCA and six others, recently surveyed our respective members to learn about PPE needs on a county basis. The survey was requested by the state Department of Health. It was designed and analyzed by LeadingAge New York who shared it with partner associations for circulation, drawing responses from 600 individual home care, hospice and adult care facility organizations. These responses aggregated up to 918 county-specific answers, since many organizations serve more than one county.
The purpose was to determine the counties in which unmet needs existed for specific types of PPE, and to what extent. Responses were wide-ranging. For instance, 77 percent of organizations said their county wasn’t providing them with N95 masks; yet nearly half of providers who reported this absence of county-provided PPE also said they hadn’t requested supplies from their county, and many providers indicated that they did not know they could do so. (Similar percentages of unmet need were reported for other types of PPE.) Many providers were also told they were not a priority or were not ‘on the list’ by the county.
The associations are still analyzing the data for next steps in our discussions with state officials on PPE supply issues, including coordination issues at the local level.
State Guidance on Pediatric Multi-System Inflammatory Syndrome Associated With COVID-19
As of May 5, 64 suspected pediatric clinical cases compatible with multi-system inflammatory syndrome have been reported in children in New York State hospitals, including New York City.
This syndrome has features which overlap with Kawasaki Disease and Toxic Shock Syndrome. Inflammatory markers may be elevated, and fever and abdominal symptoms may be prominent. Rash also may be present.
Hospitals must immediately report such cases that are suspected to be COVID-19-related cases in patients under age 21. They must also perform a diagnostic and serological test to detect the presence of SARS-COV-2, the virus that causes COVID-19, or corresponding antibodies in the patient.
IRS Guidance on Tax Deductibility of PPP Funds
The Internal Revenue Service (IRS) has released guidance on federal income tax deductibility for certain expenses incurred when the taxpayer receives a loan under the Paycheck Protection Program (PPP), which is the expanded small business loan and loan forgiveness program under the Small Business Administration (SBA).
Specifically, it clarifies that no deduction is allowed for an expense that is otherwise deductible if the payment of that expense results in forgiveness of a covered loan under the CARES Act (the COVID-19 relief bill) and the income associated with the forgiveness is excluded from gross income.
National Cyber Awareness System Activity Alert
A joint alert from the U.S. Department of Homeland Security and the United Kingdom’s National Cyber Security Centre on May 5 contains information on continued exploitation by advanced persistent threat (APT) groups seizing on COVID-19 global pandemic vulnerabilities. It describes the methods these actors are using to target organizations and provides mitigation advice. Among those targeted are health care, pharmaceutical, academia, medical research and local government organizations. For more detailed information, see here.
COVID-19: Respirator Use
The Occupational Safety and Health Administration (OSHA) has released a new video and poster (available in English and Spanish) with step-by-step instructions on how to properly wear and remove a respirator.