As the spread of novel coronavirus intensifies in New York, HCA staff and members held a March 6 conference call with the state Department of Health’s (DOH) Office of Primary Care and Health Systems Management and Office of Health Emergency Preparedness to discuss the unique issues that home care, hospice and Managed Long Term Care (MLTC) plans are facing in preparedness, response and continuity of operations planning amid the global COVID-19 threat.
In response to HCA’s request for written guidance for the home and community-based care sector (as most of the information, to date, has been for other sectors), DOH said that it will be releasing such material today or sometime this week.
On the call, HCA and members raised numerous issues, including the need for state officials to request or facilitate waivers of certain state and federal regulations, including those related to: in-service training, service authorizations, supervision requirements, physician face-to-face requirements, OASIS and other assessment timeframes, and permissibility of and reimbursement for telephonic/remote patient monitoring in lieu of in-person visits. We also urged priority access to supplies like N95 masks and raised issues where guidance or clarification is needed on: how to address patients who don’t want anyone coming into their home; whether agencies can send staff to conduct throat swabs of individuals suspecting of having coronavirus; the potential effect of school closings and public transportation curtailment on supply of aides and other staff; and more.
HCA will be following up on all of these issues with DOH and asks that you e-mail other concerns to Andrew Koski at email@example.com.
State of Emergency
Meanwhile, on March 7, Governor Cuomo declared a state of emergency (https://www.governor.ny.gov/news/video-audio-photos-rush-transcript-novel-coronavirus-briefing-governor-cuomo-declares-state) “to help New York more quickly and effectively contain the spread of the virus.”
According to the Governor, this declaration allows, among other things:
- Expedited procurement of cleaning supplies, hand sanitizer and other essential resources;
- Qualified professionals other than doctors and nurses to conduct testing;
- Expedited procurement of testing supplies and equipment;
- Expedited personnel onboarding;
- Expedited leasing of lab space;
- EMS personnel to transport patients to quarantine locations other than just hospitals; and
- Investigate and enforce instances of price gouging.
This declaration follows earlier action where, on March 3, the Governor signed legislation that appropriates $40 million for services and expenses related to the outbreak of novel coronavirus.
The legislation also: clarifies that a disaster declaration can be issued for an urgent or impending threat of widespread injury or loss of life resulting from disease outbreak; allows the Governor to suspend any statute, local law, rules or regulations if necessary to “assist or aid in coping” with a state disaster emergency; and allows the Governor to issue any directive needed to cope with a disaster along with procedures to enforce such directives.
HCA reminds members to check our dedicated emergency preparedness website (http://homecareprepare.org/) for the latest information and resources on COVID-19.
On March 6, the U.S. Centers for Medicare and Medicaid Services (CMS) issued frequently asked questions and answers (FAQs) for health care providers regarding Medicare payment for laboratory tests and other services related to COVID-19. They are at https://www.cms.gov/files/document/03062020-covid-19-faqs.pdf.
This follows CMS action on March 5, 2020 to issue a second Healthcare Common Procedure Coding System (HCPCS) code for certain COVID-19 laboratory tests, in addition to three fact sheets about coverage and benefits for medical services related to COVID-19 for CMS programs (https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests).
Earlier, on March 4, CMS also announced that State Survey Agencies and Accrediting Organizations will focus their facility inspections exclusively on issues related to infection control and other serious health and safety threats, like allegations of abuse – beginning with nursing homes and hospitals – effective immediately and until further notice.
CMS also issued three memoranda to State Survey Agencies, State Survey Agency directors and Accrediting Organizations about inspecting thousands of Medicare-participating health care providers across the country, including nursing homes and hospitals.
The first memorandum provides important detail with respect to the temporary focus of surveys involving infection-control and other emergent issues. Importantly, it notes that, in addition to the focused inspections, statutorily-required inspections will also continue in the 15,000 nursing homes across the country using the approximately 8,200 state survey agency surveyors. Surveys will be conducted according to the following regime:
- All immediate jeopardy complaints (a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death or harm) and allegations of abuse and neglect;
- Complaints alleging infection-control concerns, including facilities with potential COVID-19 or other respiratory illnesses;
- Statutorily required recertification surveys (nursing home, home health, hospice, and Intermediate care facilities);
- Any re-visits necessary to resolve current enforcement actions;
- Initial certifications;
- Surveys of facilities/hospitals that have a history of infection-control deficiencies at the immediate jeopardy level in the last three years;
- Surveys of facilities/hospitals/dialysis centers that have a history of infection-control deficiencies at lower levels than immediate jeopardy.
More information is at https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus while the memoranda are available at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions.