Important note: when examining the resource links below, please be mindful of dates (wherever labelled) to ensure that you are reading the most recent guidance or update. Please also be sure to refresh your browser to ensure that you are viewing the most current file, as information is being continuously updated.
HCA Vaccine Checklist
HCA Member Vaccine Forum Slide Deck: January 13, 2021
- Download the slide deck from HCA’s January 13, 2021 forum for home care and hospice providers on the vaccine rollout
Vaccine Dispensing Sites and Appointment Links
On January 5, 2021, the state Department of Health moved home care and hospice staff to week 4 of the vaccine priority schedule (beginning January 4, 2021). Please encourage your staff to use the links below to make vaccine appointments. Please also use HCA’s vaccination readiness checklist to guide staff through the vaccination process. Also below we’ve included a table of county health department information with links to the counties’ public-facing websites where they’ve posted vaccine information.
- Statewide (NYS DOH) vaccine eligibility and appointment app
- NYC Department of Health vaccine appointment page
Regional Advisory Task Force (RATFs) Vaccination Websites
Below are websites for each of the RATFs overseeing vaccination in each region. In addition, HCA has compiled a list of contacts for each of the RATFs in the event that providers are experiencing issues with vaccination or are seeking to make arrangements directly with the RATFs for vaccination.
- NYC and Greater New York Hospital Association (GNYHS)
- Long Island/Northwell Region
- Hudson Valley/Westchester Medical Center
- Mohawk/Mohawk Valley Health System
- Central NY/SUNY Upstate Medical Center
- North Country/Champlain Valley Physicians Hospital
- Capital Region/Albany Medical Center
- Southern Tier — United Health Services (awaiting website information)
- Finger Lakes — University of Rochester Medical Center (awaiting website information)
- Western NY — Catholic Health System, Buffalo (awaiting website information)
Vaccine Education Resources and Information
Please utilize the following resources to communicate the effectiveness and the importance of the COVID-19 vaccine among staff and patients. Vaccine hesitancy is real. The following resources can help overcome it.
- Vaccinate New York Education Page
- New York State COVID-19 Vaccine Education Toolkit
- CDC’s COVID-19 Vaccination Communication Toolkit for Providers
- CDC Benefits of Vaccine
- CDC Answering Patient Questions
- CDC Recipient Education
- CDC Busting Myths about the Vaccine
- CDC Promoting Vaccination in the Workplace
- Immunize Action Coalition — Talking about Vaccines
- Health Info Translations
- Healthcare Professionals: Preparing for COVID-19 Vaccination
- Vaccine Information for You and Your Family
- 8 Things to Know about Vaccine Planning
- How CDC Is Making COVID-19 Vaccine Recommendations
- Ensuring the Safety of COVID-19 Vaccines in the United States
Other Vaccine Resources and Information
DOH Vaccine Website
New York State has launched a new website dedicated to COVID-19 vaccine information. It includes information about the vaccine, the state’s distribution plan, safety measures, the process for providers to order the vaccine, frequently asked questions, and more.
DOH has also posted the following additional resources:
- A guidance document reminding and informing vaccine administrators of their obligations when reporting the New York State Immunization Information System and the City Immunization Registry.
- Instructions on the newly developed COVID-19 Vaccine Form, which providers should encourage all patients to complete before receiving the vaccine.
- A template COVID-19 Immunization Screening and Consent Form.
- A screening checklist for health care providers.
- Medicaid Reimbursement for Vaccine Administration: The state Department of Health (DOH) has posted guidance on New York’s Medicaid reimbursement policy for the administration of COVID-19 vaccines authorized for emergency use and instructions for providers to bill the cost of administration of authorized COVID-19 vaccine.
NYS and NYC Vaccine Registries
HCA encourages members to enroll in the city or state immunization registries and vaccination enrollment programs. New York City providers should consult the following resources:
- Fact Sheet on Preparing for COVID-19 Vaccination
- December 8 “Dear Colleague” Letter on Vaccine Enrollment
Providers outside of New York City should consult the following resources:
- December 3 “Dear Health Care Provider” Letter on COVID-19 Vaccine Enrollment
- Checklist to Go Live with the New York State Immunization Information System (NYSIIS)
- The U.S. Centers for Disease Control and Prevention (CDC) has provided several resources on the COVID-19 vaccine, including slides from a December 13 webinar on what practitioners should know about the Pfizer vaccine, and guidance on post-vaccine considerations for healthcare personnel.
COVID-19 Counseling and Emotional Support Helpline
Project Hope is New York’s COVID-19 Emotional Support Helpline.
NY Project Hope helps New Yorkers understand their reaction and emotions during the COVID-19 pandemic. Through an emotional support helpline, educational materials, and trusted referrals, NY Project Hope helps people manage and cope with changes brought on by COVID-19.
Emotional Support Helpline: 1-844-863-9314
General PPE Suppliers
The Nassau County Department of Health Office of Emergency Management has shared a list of vendors that may have personal protective equipment (PPE) available for purchase during the pandemic. “Please note that while we hope to assist your agency in locating reliable sources for PPE during this difficult time, currently the supply chain for these products is strained beyond capacity, and this list is provided as a courtesy and for informational purposes only and not a guarantee that the products are available,” Nassau County notes. “In addition, this list does not constitute or imply Nassau County’s recommendation or endorsement of these vendors. Nassau County is not responsible if a vendor defaults, fails to perform, or if you are not satisfied with their services in any way.”
The New York City Health Department has shared a list of Personal Protective Equipment and Medical Supply Companies. “This list is neither exclusive nor exhaustive,” NYC notes. “The NYC Health Department is providing this information to assist New Yorkers locate services and for general information but does not make any representation or warranty concerning the quality or accuracy of the services provided by these identified establishments.”
PPE Supplies from NYC Stockpile
CHHAs and LHCSAs who provide home care services in New York City (NYC) and meet certain criteria are able to order personal protective equipment (PPE) from Medline, a company selected by NYC to provide PPE to health care providers. Providers must pre-register for this process. If you have not done so already, please write to PPEsupport@health.nyc.gov.
The NYC stockpile of PPE via Medline will act as a last-case, emergency option for providers after all other options have been exhausted. By submitting a request through medline.com, organizations confirm that the PPE is required to protect staff and patients during the COVID-19 response
and that the agency currently has less than one week of the requested supplies on hand. Note: As of around December 7, this latter requirement was removed by NYC and providers need not have less than a week of supplies to make orders through this process.
Questions about the Medline distribution process can be directed to the NYC customer service desk at 866-478-1490, ext. 2222.
Current Regulatory Waivers, Changes (Updated 12/15/20)
Below is a summary of current regulatory waivers. Please note that while some may be issued at the federal level, this does not mean that the state has necessarily also recognized the same changes in parallel fashion. Please also note that waivers may have differing end dates and others involve the postponement of requirements until certain defined dates in relation to the emergency declaration period. Providers should not rely strictly on the summaries below and should always read the source documents linked accordingly for further details, contingencies and context.
Medicare Home Health Telehealth Services: On March 30, CMS issued a very incremental allowance for home telehealth. Congress, in the recently enacted CARES Act for coronavirus relief, called upon federal officials to “encourage” telehealth. CMS has responded in a limited fashion, determining that the law does not permit CMS to pay home health agencies for telehealth. (The state Medicaid program, meanwhile, has already provided much more flexibility in this regard for Medicaid services, as reported below.) CMS is ostensibly allowing expanded telehealth as a means to reduce costs, but not as a service billable under Medicare.
Medicare “Homebound” Requirement: On March 30, CMS determined that an individual meets the requirement for “homebound” status if needing skilled services and if deemed by a physician at high risk of contracting COVID-19 due to a compromised health condition.
Medicare Home Health Conditions of Participation (CoPs) and NPP Certifications: CMS reported on March 30 that CoPs related to onsite home health aide supervision and in-person initial patient assessments can now be done remotely. CMS has also implemented language from the CARES Act permitting non-physician practitioners (nurse practitioners, physician assistants, and certified nurse specialists) to order and refer for Medicare home health services. This is understood to now be a permanent allowance (not just for the emergency period) and it is retroactive to March 1, 2020. (See a summary document from the National Association for Home Care and Hospice here.) HCA stresses that we are still awaiting confirmation from state officials whether the state is also recognizing NPP certifications for the same disciplines as defined by CMS.
Medicare OASIS/RAPs: The federal disaster declaration provides relief to home health agencies on the timeframes related to OASIS Transmission. It allows Medicare Administrative Contractors to extend the auto-cancellation date of Requests for Anticipated Payment (RAPs) during emergencies (see the CMS fact sheet here).
Hospice Telehealth: CMS reported on March 30 that it is allowing use of telehealth for the physician face-to-face encounter requirement in hospice and is permitting telehealth billing by hospice physicians.
Hospice Volunteers, Assessments, Non-Core Services, Supervision: Per the CARES Act, CMS announced on March 30 that it is waiving: the requirement for hospices to use volunteers; timeframes for updating comprehensive patient assessments; non-core services requirements; and the 14-day home health aide in-person supervisory requirements, consistent with home health waivers. It has also suspended all medical review audits other than in cases of fraud investigation.
Federal Quality Reporting Requirements: On March 22, CMS announced some additional quality reporting program relief for providers. Home health data from January 1, 2020 through June 30, 2020 does not need to be submitted to CMS for purposes of complying with quality reporting program requirements. In addition, Home Health and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from January 1, 2020 through September 30, 2020 does not need to be submitted to CMS.
Aide In-Service, On-site Supervisory Visits, QAPI and Furnishing Medical Records to Patients: On April 30, CMS announced several blanket waivers including postponement of the 12-hour annual in-service training requirement for home health aides*; waivers of certain discharge planning information requirements that include the coordination of information about post-acute care receiving organizations; extended deadlines for agencies to provide patients with copies of their medical records; waiving the home health and hospice requirements related to annual onsite supervisory visits; a narrower scope of Quality Assurance and Performance Improvement (QAPI) program requirements in home care and hospice; as well as postponing the requirement that hospices annually assess the skills and competence of all individuals furnishing care and provide in-service training and education programs.
*Important note: On October 13, the state Department of Health informed providers that its surveyors will exercise “enforcement discretion” when surveying providers for compliance with aide in-service requirements that have been waived by the federal government. HCA advises agencies to exercise caution in relying on enforcement discretion by individual surveyors and to document all efforts to meet the requirements, as well as document any barriers to compliance.
Vaccination and Specimen Collection by Non-Nurses and other Vaccination Flexibilities: Executive Order No. 202.82 allows non-nursing staff, if they are adequately trained, to do the following: obtain specimens for COVID-19 testing; collect blood specimens for diagnosis of acute or past COVID-19 disease; administer vaccinations against influenza or COVID-19; and “perform tasks, under the supervision of a nurse, otherwise limited to the scope of practice of a licensed or registered nurse to provide care for individuals diagnosed or suspected of suffering from a COVID-19 or influenza infection.” The order also allows physicians and certified nurse practitioners to issue a non-patient-specific regimen to nurses, physician assistants, specialist assistants, pharmacists and others to: collect specimens, for purposes of testing; collect blood specimens for diagnosis of COVID-19; and administer vaccinations against influenza or COVID-19. It also clarifies requirements for nurses to have CPR training “insofar as [state regulation] requires a registered professional nurse authorized to administer immunization agents pursuant to a non-patient specific order to be currently certified.”
The order also allows for RNs to administer vaccinations for influenza and COVID-19 without reporting to the attending physician; but they must report, at a minimum, to the New York State Immunization Information System (NYSIIS) or Citywide Immunization Registry (CIR) as applicable
Immunization Reporting to Attending Physician: Executive Order No. 202.82 allows for RNs to administer vaccinations for influenza and COVID-19 without reporting to the attending physician; but they must report, at a minimum, to the New York State Immunization Information System (NYSIIS) or Citywide Immunization Registry (CIR) as applicable.
CPR Certification When Administering Immunizations: Executive Order No. 202.82 clarifies that “registered professional nurses must have a current certificate in basic cardiopulmonary resuscitation” … “insofar as [state regulation] requires a registered professional nurse authorized to administer immunization agents pursuant to a non-patient specific order to be currently certified in cardio-pulmonary resuscitation (CPR).” This is consistent with existing regulations as they apply to administration of immunizations, emergency treatment of anaphylaxis, and other tests, treatments and screenings associated with non-patient specific orders and protocols.
Medicaid Telehealth Use, Billing: A special edition of the state’s Medicaid Update on March 21 and updated on March 23 (see here) includes a guidance broadly expanding the use of telehealth, telephonic services, and other communications methods by Medicaid providers during the COVID-19 state of emergency. This guidance was followed up with an extensive frequently asked questions document issued on March 31 (see here). Effective for dates of service after March 1, and for the duration of the state of emergency, “New York State Medicaid will reimburse telephonic assessment, monitoring, and evaluation and management services provided to members in cases where face-to-face visits may not be recommended and it is appropriate for the member to be evaluated and managed by telephone.” HCA has confirmed with DOH officials that the guidance applies to Article 36 home care providers and the March 23 version of the guidance provides more specific home care service and billing codes. It adds: “All telephonic encounters documented as appropriate by the provider would be considered medically necessary for payment purposes in Medicaid fee for service or Medicaid Managed Care.”
RN Supervision Visits Under Medicaid Personal Care: Governor’s Executive Order No. 202 “permit(s) nursing supervision visits for personal care services provided to individuals affected by the disaster emergency be made as soon as practicable” (emphasis added) in place of requirements for such visits to be made “at least every 90 days.”
Employee Health Assessments, Performance Evaluations, Aide Training: In an April 10 Dear Administrator Letter (see here) to CHHAs, LHCSAs, LTHHCPs, and Hospice programs, the state Department of Health has suspended or changed the following regulations.
The annual health assessment has been temporarily suspended for all employees. On November 23, 2020, the state issued a new DAL stating that it is lifting its suspension of the annual health assessment for all personnel. All personnel are advised to obtain an annual health assessment by December 31, 2020.
Annual performance evaluations of current employees by home care agencies and programs are temporarily suspended.
The time in which a home care aide training program must be completed is extended to 90 days (HCA asked for 120 days).
The Alternate Competency Demonstration look-back period is expanded to 3 years, from 2 years, and the prospective employee must have 3 months of experience, rather than 6 months.
The time period is extended by which home health aide training programs must submit an intent to submit a class schedule to regional offices (April 1, 2020 to July 1, 2020).
New employees may have health assessments completed by telehealth or by an RN. New employees must follow guidelines in place for all staff, including daily symptom screenings and at least daily temperature checks.
All CHHAs, LTHHCPs, AIDS home care programs and LHCSAs serving individuals affected by the COVID-19 public health emergency may conduct in-home and in-person supervision through indirect means, including by telephone or video communication, as soon as is practicable after the initial visit.
Supervised Practical Training: In an April 10 health advisory (see here), the state Department of Health waives the requirement that 8 hours of the 16 hours of supervised practical training must be provided in a patient care setting.
Opening Cases: All CHHA, LTHHCP, AIDS home care and LHCSA home care cases may be opened using remote technology (see the April 10 Dear Administrator Letter from the state Department of Health).
Medicaid Program Initial Service Visit, Home Care Registry, Supervision Visits, Fair Hearings: Governor’s Executive Order No. 202.5:
To the extent necessary to permit certified home health agencies, long term home health care programs, AIDS home care programs, and licensed home care services agencies serving individuals affected by the disaster emergency to conduct in-home supervision of home health aides and personal care aides as soon as practicable after the initial service visit, or to permit in-person and in-home supervision to be conducted through indirect means, including by telephone or video communication.
To the extent necessary to permit initial patient visits for certified home health agencies, long term home health care programs and AIDS home care programs serving individuals affected by the disaster emergency to be made within 48 hours of receipt and acceptance of a community referral or return home from institutional placement.
To extend the time in which home care services entities must submit information to the Home Care Worker Registry. This extension was discontinued in a later Executive Order, effective May 8.
To the extent necessary to allow or require appearance by any parties to a fair hearing by written, telephonic, video or other electronic means.
Record-keeping: Executive Order No. 202.10 provides relief from record-keeping requirements. It mentions “relief to the extent necessary for health care providers” … “including, but not limited to, requirements to maintain medical records that accurately reflect the evaluation and treatment of patients, or requirements to assign diagnostic codes or to create or maintain other records for billing purposes,” granting “absolute immunity from liability for any failure to comply with any recordkeeping requirement” if done so in good faith except in certain circumstances. This extension was discontinued in a later Executive Order, effective May 8.
RN Orders and Billing for COVID-19 Specimen Samples: Executive Order No. 202.10 “permits registered nurses to order the collection of throat or nasopharyngeal swab specimens from individuals suspected of being infected by COVID-19, for purposes of testing.” In November 2020, the state Department of Health issued new rate codes for Certified Home Health Agencies to bill for COVID-19 specimen collection under fee-for-service Medicaid.
EISEP: Governor’s Executive Order No. 202.1 suspends regulations related to assessments, reassessments and duration of care plan for home delivered meals and/or Expanded In-Home Services for the Elderly Program (EISEP). Governor’s Executive Order No. 202.18 expands eligibility for home delivered nutrition programs to anyone over the age of 60, waives certain dietary requirements and the need for menus to be approved by a registered dietician, and relaxes the minimum number of meals per week that are required to be served; Removes the requirement for an in-home visit within five days of first services provided; allows for new clients to receive services without paying any cost sharing, until an assessment can be conducted and a cost sharing amount determined; and allows contact to be conducted by phone or otherwise remotely.
Out-of-State Practitioners: Governor’s Executive Order No. 202.18 allows physicians, nurses, physician assistants, radiologic techs, and clinical nurse specialists, licensed social workers, licensed and in good standing in any other state or province in Canada, to practice in New York.
Medicaid Transportation Services: According to a March 21 letter, transportation managers shall: waive the 72-hour rule for enrollees requesting urgent trips for COVID-19 related symptoms; prohibit multi-loading vehicles, including group rides. Multi-loading shall only be approved in situations where no single loading alternative exists and must be specially approved by the manager/broker.
Medicare and Medicaid Face-to-Face Requirements: For clarification, below are the Medicare and Medicaid face-to-face (F2F) requirements including the extent to which telehealth or telephony are permissible or not.
Medicare: The physician F2F encounter can be performed via telehealth. Under the expansion of the telehealth waiver, beneficiaries can use telehealth modalities with their doctors and practitioners from home for the face-to-face encounter to qualify for Medicare hospice and home health care services. As of April 7, 2020, the telehealth mechanism must be two-way live video. The federal government has relaxed HIPAA enforcement so that commonly available platforms like Skype, Facetime and Zoom may be used for telehealth purposes.
Medicaid: The physician F2F encounter can be performed via telehealth including telephonic means. Medicaid Update, Volume 36 (on March 23, 2020) indicated that provider must be enrolled in the New York State Medicaid program. Physicians, nurse practitioners can complete the necessary F2F documentation
Home Care, Hospice and Managed Care Guidance or Resources
- DOH Health Advisory: Nursing Home Staff Testing and Payment Requirements, applicable to home care contract staff. Note: Effective June 10, 2021, DOH has eliminated the requirement that adult care facility (ACF) and nursing home staff (including contract staff from home care or hospice agencies) receive COVID-19 tests either once (in ACF) or twice (in nursing homes) per week, provided that the staff are fully vaccinated (June 10, 2021)
- DOH Health Advisory: Revised Protocols for Personnel in Healthcare and Other Direct Care Settings to Return to Work Following COVID-19 Exposure or Infection (UPDATED April 22, 2021)
- New York State Department of Labor Guidance on the Use of Sick Leave for COVID-19 (January 20, 2021)
- DOH New York State Medicaid Coverage Policy and Billing Guidance for the Administration of COVID‑19 Vaccines Authorized for Emergency Use (January 2021)
- CMS COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing (UPDATED August 7, 2020)
- CMS COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies (June 29, 2020)
- DOH Update: Home and Community-Based Services Regarding COVID-19 (UPDATED June 18, 2020)
- DOH Guidance for Home Health Aide and Personal Care Aide Training Programs (June 2, 2020)
- DOH Health Advisory: Symptom-based Strategy to Discontinue Home Isolation for Persons with COVID-19 (May 30, 2020)
- DOH COVID-19 Guidance: Voluntary Plan of Care Schedule Change (April 23, 2020)
- DOH COVID-19 Guidance for Managed Care Organization Contracting and Surveillance Relief (April 8, 2020)
- DOH COVID-19 Guidance for the Authorization of Community-Based Long-Term Services and Supports Covered by Medicaid (UPDATED April 8, 2020)
- DOH Health Advisory: Options when Personal Protective Equipment (PPE) is in Short Supply or Not Available (April 2, 2020)
- DOH Frequently Asked Questions (FAQs) on Medicaid Telehealth Guidance during the Coronavirus Disease 2019 (COVID-19) State of Emergency (March 31, 2020)
- DOH Medicaid Changes to Private Duty Nursing (PDN) Policy (March 28, 2020)
- DOH COVID-19 Guidance for Home Health Care Agencies and Hospice Providers (March 22, 2020)
- DOH Interim Guidance for Home Care Services Regarding COVID-19 (March 16, 2020)
- DOH COVID-19 Guidance for Children’s Waiver Services Providers (March 14, 2020)
COVID-19 Specimen Collection and Testing
- DOH Guidance with Details about CHHA Medicaid FFS Rate Codes for Specimen Collection (UPDATED November 2020)
- HCA E&R Home Care Clinician Training for COVID‐19 Testing Testing Initiative Launch Webinar (May 28, 2020) Post‐Webinar Questions and Answers (Q&As)
- DOH Updated Interim Guidance: Protocol for COVID-19 Testing Applicable to All Health Care
Providers and Local Health Departments (UPDATED May 31, 2020)
- DOH Guidance on COVID-19 specimen collection and handling, including the use of nasal and oropharyngeal swabs as an alternative when nasopharyngeal are not available (March 25, 2020).
Guidance on Face Masks and PPE
- HHS and FEMA Fact Sheet on Coronavirus (COVID-19) Pandemic: Personal Protective Equipment Preservation Best Practices
- New York City Department of Health Overview of Strategies for Reuse and Extended Use of Personal Protective Equipment
- CMS Guidance for use of Certain Industrial Respirators by Health Care Personnel
State and City Departments of Health General Guidance
- NYC Department of Health Advisory on Proper Use and Interpretation of SARS-CoV-2 Antigen Tests
- NYC Department of Health Alert on Face Mask Use Policy, Swab Shortage, Reporting COVID-19 Related Deaths and Crisis Communication Resources
- DOH Guidance on the Contacts of a Close or Proximate Contact of a Confirmed or Suspected Case of COVID-19
- NYC Department of Health 2019 Novel Coronavirus (COVID-19) — Information for Providers
- DOH Novel Coronavirus Information for Providers
- DOH What You Should Know about the Flu
- DOH Interim Guidance for Procedures When Identifying an Employee with Concerns for COVID-19 Exposures