COVID-19 Updates for the Week Ending May 31, 2020

What follows are the most salient COVID-19 updates for HCA members as of the week ending May 31.

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.

To catch up on all COVID-19 updates, please see the news feed on our “home care prepare” website (here), including our resource page with COVID-19 regulatory waivers, guidance and more (here).

Act Now: Online Advocacy Campaign Urging Congressional Funds

In an online advocacy action item sent to members on Thursday, HCA is asking home care providers to write Congress urging federal funds. 

This grassroots advocacy campaign follows a letter that HCA President and CEO Al Cardillo sent to all members of New York’s Congressional Delegation explaining the distinct impact of COVID-19 on New York home care providers at the pandemic epicenter who, we estimate, have weathered losses of at least $200 million — a conservative estimate of the baseline funding need. (See also the related Home Health Care News report “New York Home Health Agencies Facing $200 Million in 2020 Losses Due to COVID-19.”)

If you have not acted on this campaign, please do so today, and urge your staff to do the same.

It takes only a minute of your time by clicking a link here, completing a form with your contact information, and hitting the send button.

As of Friday afternoon, approximately 1,300 messages have been sent to Congress using our platform, but many more messages are needed to make an impact with all members of New York’s Congressional Delegation. This is the kind of campaign that demands a multiplier effect; so please pass this information along to as many people as possible and urge them to act in the thousands.

If your agency has been financially impacted by COVID-19 — and undoubtedly it has — your voice is urgently needed.

State Legislature Adjourns After Flurry of COVID-19 Bills

After passing myriad COVID-19-related bills late last week, the state Legislature adjourned in advance of their scheduled June 2 session end date. Lawmakers had returned last week after a seven week hiatus due to COVID-19.

A total of 32 bills were passed between Tuesday and early Friday morning, including legislation related to health care employee whistleblower protections; price gouging of medical supplies and services; audio-only Medicaid telehealth services; pharmacist administration of COVID-19 vaccines; public employee death benefits; and other consumer protection, business, education, and labor and employment-related bills.

It is unclear at this time whether lawmakers will return to Albany to continue work. It has been rumored that state legislators may return based upon the timing of Congressional action in Washington, D.C. on a federal aid package. We will keep members updated as we learn more about the state’s intentions.

HHS Announces 45-Day Extension for Providers to Accept Terms & Conditions of Federal Relief Payments

The U.S. Department of Health and Human Services (HHS) recently announced a 45-day deadline extension for providers who are receiving payments from the Provider Relief Fund to accept the Terms and Conditions for Provider Relief Fund payments. This announcement means providers have now been granted 90 days from the date they received a payment to accept HHS’s Terms and Conditions or return the funds.

HHS’s announcement can be found here.

All providers who have received Provider Relief Fund payments must agree to the program Terms and Conditions if they wish to keep the funds. This funding supports healthcare-related expenses or lost revenue attributable to COVID-19.

HHS previously announced that $50 billion of the Provider Relief Fund was allocated for general distribution to facilities and providers that bill Medicare and were impacted by COVID-19, based on eligible providers’ net patient revenue. A sum of $30 billion was distributed immediately, proportionate to providers’ share of Medicare fee-for-service reimbursements in 2019. Then, beginning on April 24, HHS began distributing an additional $20 billion to providers based on their share of net patient revenue. It also began accepting submissions from eligible providers of their financial data.

HCA members can find additional information on the terms and conditions of these relief fund payments here.

HCA members that have not received their payments or have specific questions should contact the HHS Provider Relief line at 866-569-3522.

Cuomo and Trump Meet, Plus Reopening Developments

Governor Cuomo met with President Trump on Tuesday, May 26. The two leaders reportedly discussed infrastructure projects and the Governor’s call to fund them as part of New York’s reopening plan and economic stimulus.

The Governor in his briefings throughout the past week also reported that additional regions began the phased “reopening” process, including the mid-Hudson region and Long Island. Five other regions are already poised to enter the second phase of reopening.

The only region that has yet to start the reopening process is New York City, which the Governor said was on track to begin doing so around June 8.

Different regions of the state are in different stages of the reopening process. The four stages start with the resumption of construction and manufacturing activity (phase 1), followed by certain services sectors (retail, professional, real estate), then restaurants and food services (phase 3) and, in the final phase, education and arts and entertainment (phase 4). The progression of these phases is dictated by seven metrics previously summarized for the membership. 

Regional Control Groups have also been established to monitor and respond to any evidence of a resurgence in case counts, hospitalization rates or other metrics prompting a draw-back to prior economic closure measures. 

With Velázquez Bill, Verbal Orders Would Suffice in Emergencies

New York Congresswoman Nydia Velázquez has introduced a bill that would allow for verbal physician or non-physician practitioner (NPP) orders in lieu of signed orders for home health during an emergency period — legislation strongly supported by HCA.

The bill is called the “The Improving Home Health Service Act” and it would specifically amend the 1135 waivers to allow this kind of procedural relief among the other waivers permitted during a public emergency.

Congresswoman Velázquez’s office reached out to HCA for a statement of support. “The Improving Home Health Service Act supports home health agencies and physicians by enabling both to maximize direct service to patients instead of time spent on paperwork exchanges between them,” said HCA President and CEO Al Cardillo in the statement. “This legislation will help avoid Medicare payment delays for in-home services provided to beneficiaries at a time when New York’s home health agencies are already reeling financially as a direct result of the COVID-19 pandemic. We applaud Congresswoman Velázquez for her support.”

Webinar Launch of “Home Care Clinician Training for COVID-19 Testing”

On Thursday, May 28, HCA held a webinar launch of our new initiative — with grant support from the Mother Cabrini Health Foundation — to provide training on COVID-19 nasopharyngeal specimen collection procedures by home care professionals.

If you missed the webinar, no problem: an archive is posted to our website here.

It provides background on the imperative for home care clinicians to learn and apply testing in the home care setting. It also explains how to sign up for this on-demand training coordinated with our project partners at the Iroquois Healthcare Alliance and faculty from the Mohawk Valley Health System (MVHS). 

We strongly urge all home care providers to take advantage of this complimentary offering vital to the public health response and the safety of your patients and staff.

DOH Reverses Course on Testing Requirement for Home Care and Hospice Agencies Serving SNFs, ACFs

As HCA announced in an alert on Friday, May 29, the state Department of Health (DOH) has abruptly reversed course on its policy regarding the applicability of COVID-19 testing requirements for home care and hospice personnel serving patients in skilled nursing facilities (SNFs) and adult care facilities (ACF).

The matter has caused major confusion across the field. To clarify, this issue only applies in cases where a home care or hospice agency has staff who work in a SNF or ACF, in which case the home care staff are subject to the same testing requirements otherwise imposed on SNFs/ACFs.

Those staff, when working in the SNF/ACF, must be tested twice per week if they work four days or more and once per week if they work there three days or less.

HCA raised concerns regarding the lack of appropriate notice to the home care and hospice provider community about the applicability of this requirement. The change in policy directly contradicted a prior set of FAQs stating that the home care and hospice staff were exempt. Please see last week’s alert for further background and links to the state’s FAQs

HCA has requested reconsideration of the policy, citing the direct and indirect impacts on workers, agencies and patients, as well as the unresolved questions of testing access, cost, service and more.

The policy change was reportedly made at the direction of the Governor’s office, with no reconsideration expected at DOH.

May 2020 Capitol Report Continues COVID-19 Features

Last week, HCA circulated our May 2020 edition of the Capitol Report, a monthly e-newsletter for the state Legislature and state officials. It highlights HCA’s “national model” program for COVID-19 testing in home care, which we launched last week in a webinar to providers.

We also outline the need for federal and state coordination on funding needs to providers weathering an estimated $200 million in losses as a direct consequence of COVID-19, plus some recent media reports from NBC News, an HCA op-ed on the Empire Report, Home Health Care News, Home Care Pulse, Crain’s Health Pulse and elsewhere describing home care’s work and needs in the COVID-19 response.

DOH Health Advisory on Discontinuing Home Isolation

The state Department of Health has issued a Health Advisory on symptom-based strategy to discontinue home isolation for persons with COVID-19.  In it, DOH states that it is adopting the U.S. Centers for Disease Control and Prevention (CDC) guidance and recommends that persons with COVID-19 illness recovering at home (or other home-like setting, such as a hotel), maintain isolation for at least 10 days after illness onset and at least 3 days (72 hours) after recovery. Illness onset is defined as the date symptoms began. Recovery is defined as resolution of fever without the use of fever-reducing medications, with progressive improvement or resolution of other symptoms.

New OSHA Guidance

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has expanded its temporary guidance (originally provided on March 14) regarding supply shortages of N95 masks or other filtering facepiece respirators (FFRs) due to the COVID-19 pandemic.

This expanded guidance applies to all workplaces covered by OSHA where respirator use is required.

OSHA reports that its field offices will exercise enforcement discretion concerning annual fit-testing requirements, as long as employers have made good-faith efforts to comply with requirements.

This expanded guidance will take effect immediately and remain in effect until further notice. It is intended to be time-limited to the current public health crisis. 

OSHA has also issued new temporary guidance regarding the enforcement of its respiratory protection standard. This guidance is aimed at ensuring health care workers have full access to needed N95 respiratory protection in light of shortages.

This temporary enforcement guidance recommends that health care employers change from a “quantitative” fit testing method to a “qualitative” testing method to preserve integrity of N95 respirators. Additionally, OSHA field offices have the discretion to not cite an employer for violations of the annual fit testing requirement under certain conditions: an employer making “good-faith” compliance efforts; use of only NIOSH-certified respirators; meeting strategies for optimizing and prioritizing N95 respirators; performing fit tests in certain circumstances (including initial fit tests and upon observing visual changes in an employee’s physical condition that could affect respirator fit); and certain employee notification and education requirements. Please see the full guidance for details.  

OSHA has also issued an alert here listing steps employers can follow to implement social distancing in the workplace such as positioning of workplace stations, how workers exhibiting symptoms should be isolated until they can go home or get medical care, establishing flexible worksites or hours, and other actions.  

Check OSHA’s webpage here for updates. 

Please also see a separate article about HCA’s upcoming members-only webinar (on Friday, June 5) for further OSHA updates that impact home care and hospice providers. Registration is here.

OIG Strategic Plan: Oversight of COVID-19 Response and Recovery

The U.S. Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS) has published a report on its Oversight of COVID-19 Response and Recovery. It sets forth the four goals related to program oversight and integrity issues, with a number of objectives related to: fraud-fighting; detecting waste of recovery funds; auditing HHS capabilities for detecting information technology vulnerabilities and incidents; and other components.

Additional information about OIG work related to COVID-19 is available here.

Center for Health Workforce Studies

The Center for Health Workforce Studies Health Workforce Technical Assistance Center (HWTAC) has been compiling data and information here on efforts to develop, deploy, and replenish the health workforce in response to the pandemic.

The site here is updated daily to provide the most current information as it becomes available. Key areas of focus include: surge capacity strategies, health workforce policies and guidelines, health workforce safety, regulatory flexibility, state workforce strategies, telehealth, and maintaining production in the educational pipeline.

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