What follows are the most salient COVID-19 updates for HCA members as of the week ending May 17.
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.
$3T Aid Package Passes House With Unlikely Support in Senate
The U.S. House of Representatives on Friday passed another large COVID-19 relief package amounting to $3 trillion. A summary of the bill is here.
The bill faces a major hurdle and stiff opposition in the U.S. Senate.
The package, called the HEROES Act, includes $100 billion in new funding assistance for the Health Care Provider Relief Fund. A portion would be allowable for expenses and another for “lost revenue.” It also would change the terms for repayment and interest on loans through the Medicare Advance and Accelerated Payment programs. Late last month, the U.S. Centers for Medicare and Medicaid Services (CMS) said it was reevaluating the amounts paid under the Accelerated Payment Program and suspending the Advance Payment Program altogether for Part B suppliers.
The package would also increase the federal share of Medicaid payments to states by 14 percent through June 30, 2021: what’s known as the Federal Medical Assistance Percentage (FMAP).
The HEROES Act does not include a “maintenance of effort” provision. Thus, under the House plan, New York could make Medicaid changes and still receive the enhanced FMAP. In addition to across-the-board Medicaid cuts enacted earlier this year, the Cuomo Administration has warned of additional mid-cycle cuts across a variety of programs in the state budget due to COVID-19 state revenue losses. (An analysis released by state Comptroller Tom DiNapoli last week pegged the state’s three-year budget gap at $25.6 billion.)
The House bill also includes a $200 billion fund for essential worker “hazard pay.” In outreach at both the state and federal levels, HCA has called for a payment mechanism to fund this area of need.
Congressional negotiations on COVID-19 relief remain in a major state of flux, with each chamber staking out wide-ranging packages and, even, different Members of Congress looking to sponsor key supports on an individual or piecemeal basis.
Among these are key provisions being advanced in a coordinated fashion by the National Association for Home Care and Hospice (NAHC), HCA, other individual state associations, and partners. This plan includes a call for increases of 15 percent in reimbursement funding, Medicare telehealth visit and billing allowances, priority status for personal protective equipment, and the ability to bill based on documented verbal orders.
HCA is also separately and strongly advocating on major funding needs for New York’s home care providers, personnel and patient services impacted by COVID-19. It is imperative that home care services in New York State, at the COVID-19 epicenter, receive substantial, targeted fiscal support that is aligned with the impact and needs of our providers and state, recognizing also that relief funds in the prior federal aid packages have yielded marginal direct aid to New York home care.
NY Applies for COVID-19 Waiver Investments
On May 11, the state Department of Health (DOH) applied for a federal Section 1115(a) waiver related to the COVID-19 public emergency seeking funds in three parts: an emergency capacity assurance fund (ECAF); a regional coordination and workforce emergency development funds (RCEDF) pool; and a rapid facility conversion initiative.
Under ECAF, New York proposes a $1.85 billion pool to stabilize providers and ensure the ongoing availability of provider capacity during and after the COVID-19 public health emergency. Funds would be available to essential providers involved or impacted by the COVID-19 emergency response, including home and community-based providers.
The RCEDF pool, requested at $900 million, would fund coordination and workforce redeployment efforts by Performing Provider Systems (PPSs). Monies would be allocated based on attribution of Medicaid lives adjusted to account for concentrations of COVID-19 cases in the region and other factors. This development pool would repurpose existing PPSs for workforce retraining and redeployment. Examples of such redeployment include: personnel conducting tests or administering vaccines; home health aide supports for monitoring and evaluating individuals in the community during the recovery phase; and community health workers to bridge social service.
The Rapid Facility Conversion fund seeks a $650 million investment for identifying and preparing infrastructure that can be rapidly converted to meet facility needs and to create flexible discharge networks with other facilities. The state is also requesting certain regulatory and waiver flexibilities for responding to capacity demands.
Also, because New York’s current 1115 waiver is set to expire on March 31, 2021, DOH requests a 12-month extension of its current Medicaid Redesign Team (MRT) waiver terms and conditions to “allow the state time to review all programs authorized under the MRT Waiver in light of the pandemic and conduct the appropriate budget neutrality review and public notice process.”
Previously, CMS rejected New York’s Delivery System Reform Incentive Payment (DSRIP) program waiver extension and renewal request.
CHHA, Hospice Survey Revisions and Repeated Call for Data Access
As announced in an alert to members late on Friday, DOH over the weekend began sending out a revised survey of Certified Home Health Agencies and hospices asking for agencies to calculate their personal protective equipment (PPE) “burn rate” and other information.
HCA conveyed to DOH the difficulties that agencies, particularly in New York City, will have in estimating how much supply they expect to receive, as the amounts change weekly. DOH said that agencies should give their best estimates.
HCA has repeatedly insisted on obtaining access to information that DOH has been collecting in its various surveys of home care and hospice providers. This data is necessary to increase situational awareness and reduce the need for duplicative or multi-source survey requests by HCA and others to inform assistance efforts on behalf of providers and their patients. We have repeatedly told the Department that the absence of this data requires HCA to separately query providers, who are already overburdened by information requests, in order to fulfill the objectives of our emergency preparedness project collaborative effort with DOH and to support providers fulfilling the state’s home and community-based service system.
Home Care and Hospice Staff in Nursing Homes
As announced in an alert last week, HCA has obtained clarification from DOH that home health and hospice staff who serve patients in skilled nursing facilities (SNFs) and adult care facilities (ACFs) are not subject to the testing requirements under Executive Order 202.30, which requires COVID-19 testing twice per week of all personnel in these latter settings. The issue arose due to a Dear Administrator Letter that referenced “contract” staff as part of the requirement. Following requests from HCA, DOH issued Frequently Asked Questions on May 12 clarifying that home care and hospice are exempt. However, we note, separate guidelines for worker screening and testing for home care and hospice continue to govern.
Also, a quality oversight and standards arm of CMS has released separate guidance to state survey agency directors on the sharing of COVID-19 case information with other organizations, including home care and other providers.
“Facilities are not required to provide the same COVID-19 information reported to residents, their representatives, and families,” the guidance says. “However, facilities would share with the visiting health care provider, if the resident receiving care is suspected of, or has laboratory-confirmed COVID-19. Any precautions the provider should take while in the facility (e.g., specific personal protective equipment) will be communicated to that provider by the facility as part of their standard practices under the infection prevention and control program requirement.”
HCA Featured in Home Care Pulse Article: 12 States Share the Ongoing Effects of COVID-19 on Home Care
HCA President Al Cardillo was featured in an article for Home Care Pulse last week with comments from state association executives in 12 states on COVID-19. The article shared a “high-level take on the state of home care in their prospective states.”
“The miracles, dedication and impact of New York’s home care agencies and personnel are at unprecedented levels,” he writes. “Home care is serving core roles in hospital decompression, surge mitigation and assistance across the continuum in addition to the extensive in-home care it provides. Agencies are also voluntarily acting as receiving and distribution sites to further render protective supplies to hundreds of fellow agencies in cases where, stunningly, no formal structure was instituted by government’s incident command to deliver these essentials to the home care sector.”
CMS Outlines Medicaid Managed Care Payment Options to States
CMS has released guidance for Medicaid Managed Care options in responding to COVID-19. See here. It provides several options that states can consider under their Medicaid managed care contracts:
- Adjusting managed care capitation rates exclusively to reflect temporary increases in Medicaid fee-for-service (FFS) provider payment rates where an approved state-directed payment requires plans to pay FFS rates.
- Requiring managed care plans to make certain retainer payments allowable under existing authorities to certain habilitation and personal care providers to maintain provider capacity and access to services.
- Utilizing state directed payments to require managed care plans to temporarily enhance provider payment under the contract.
Telehealth Video: Medicare Coverage and Payment of Virtual Services
CMS has updated a video about the expanded Medicare telehealth services benefit during the COVID-19 public health emergency. It includes how CMS adds services to the list of telehealth services, which additional practitioners can provide telehealth services and services that home health agencies can provide. As extensively reported, the circumstances remain limited for home health agencies to utilize home telehealth under Medicare, with no billing permissions. In effect, providers may use telehealth as a means to reduce costs, but not as a service billable under Medicare.
CDC Alert on Inflammatory Response in Children
The U.S. Centers for Disease Control and Prevention (CDC) has issued a Health Alert with background on recently reported multisystem inflammatory syndrome in children (MIS-C) associated COVID-19, along with a case definition. CDC recommends that providers report any patient who meets the case definition to local, state, and territorial health departments.
US DOL Guidance on Paid Leave, Unemployment Benefits
The United States Department of Labor has issued guidance on how much paid leave employees can take. It is here.
The Employment and Training Administration addressed common questions about unemployment benefits under the CARES Act.