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Intellectual & Developmental Disabilities

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Deadline Approaching: Notification Requirements of Confirmed and Suspected COVID-19 Cases Among Nursing Home Residents and Staff

On April 19, CMS announced the agency will be requiring facilities to report COVID-19 information to the CDC and to families. Within three weeks of that announcement, on April 30, CMS issued an Interim Final Rule with Comment Period with new regulatory requirements. With the new regulatory requirements, nursing homes are required to report the first week of data to the CDC beginning May 8 but no later than May 17. For the first time, all 15,000 nursing homes will be reporting this data directly to the CDC through its reporting tool.

In order to report, facilities must enroll in the CDC’s National Healthcare Safety Network (NHSN). Information on how to enroll is available here. As nursing homes report this data to the CDC, CMS will be taking swift action and publicly posting this information so all Americans have access to accurate and timely information on COVID-19 in nursing homes. More information on the CDC’s NHSN COVID-19 module can be found here.

CMS Releases Nursing Home Toolkit with Best Practices and Additional Resources

CMS released a new toolkit developed to aid nursing homes, Governors, states, departments of health, and other agencies who provide oversight and assistance to these facilities. These additional resources will help in the fight against the COVID-19 pandemic within nursing homes. The toolkit builds on previous actions taken by CMS, which provide a wide range of tools and guidance to states, healthcare providers and others during the public health emergency. The toolkit is comprised of best practices from a variety of front line health care providers, Governors’ COVID-19 task forces, associations and other organizations, and experts, and is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19.

Press Release
Toolkit

Telephone Evaluation and Management Visits

The March 30 Interim Final Rule with Comment Period added coverage during the Public Health Emergency for audio-only telephone evaluation and management visits (CPT codes 99441, 99442, and 99443) retroactive to March 1. On April 30, a new Physician Fee Schedule was implemented increasing the payment rate for these codes. Medicare Administrative Contractors (MACs) will reprocess claims for those services that they previously denied and/or paid at the lower rate.

There are also a number of add on services (CPT codes 90785, 90833, 90836, 90838, 96160, 96161, 99354, 99355, and G0506) which Medicare may have denied during this Public Health Emergency. MACs will reprocess those claims for dates of service on or after March 1.

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Hospitals: Physician Time Studies During the COVID-19 PHE

Hospitals that incur physician compensation costs must allocate those costs based on the percentage of total time spent furnishing:

  • Part A services
  • Part B services
  • Non-Medicare allowable activities

Hospitals must submit physician allocation agreements annually as part of the cost report filing process. During the Public Health Emergency (PHE), any one of these time study options is acceptable:

  • One week time study every 6 months (two weeks per year)
  • Time studies completed in the cost report period prior to January 27, the PHE effective date (e.g. hospital with a 7/1/2019 — 6/30/2020 cost reporting period, could use the time studies collected 7/1/2019 through 1/26/2020; no time studies needed for 1/27/2020 — 6/30/2020)
  • Time studies from the same period in CY 2019 (e.g., if unable to complete time studies during February through July 2020, use time studies completed February through July 2019)

For more information, see the Provider Reimbursement Manual:

  • Chapter 21, section 2182.3.E.3  – allocation agreements
  • Chapter 23, section 2313.2.E and Chapter 21, section 212182.3.E – instructions for time studies

Trump Administration Announces Call for Nominations for Nursing Home Commission

CMS announced a call for nominations for the new contractor-led Coronavirus Commission on Safety and Quality in Nursing Homes. The commission’s work will build on the Trump Administration’s long history of decisive actions to protect nursing home residents. The commission will conduct a comprehensive assessment of the overall response to the COVID-19 pandemic in nursing homes and will inform immediate and future actions to safeguard the health and quality of life for an especially vulnerable population of Americans.

Press Release
Nursing Home Commission Nominations

COVID-19: Home Health and Hospice Call — May 19

Tuesdays from 3 to 3:30 pm ET

These calls provide targeted updates on the agency’s latest COVID-19 guidance. Leaders in the field also share best practices. There is an opportunity to ask questions if time allows.

To Participate on May 19:

  • Conference lines are limited; we encourage you to join via audio webcast
  • Or, call 833-614-0820; Access Passcode: 6477704

For More Information:

Target Audience: Home health and hospice providers

COVID-19: Nursing Home Call — May 20

Wednesdays from 4:30 to 5 pm ET

These calls provide targeted updates on the agency’s latest COVID-19 guidance. Leaders in the field also share best practices. There is an opportunity to ask questions if time allows.

To Participate on May 20:

  • Conference lines are limited; we encourage you to join via audio webcast
  • Or, call 833-614-0820; Access Passcode: 4879622

For More Information:

Target Audience: Nursing home providers

COVID-19: Dialysis Organization Call — May 20

Wednesdays from 5:30 to 6 pm ET

These calls provide targeted updates on the agency’s latest COVID-19 guidance. Leaders in the field also share best practices. There is an opportunity to ask questions if time allows.

To Participate on May 20:

  • Conference lines are limited; we encourage you to join via audio webcast
  • Or, call 833-614-0820; Access Passcode: 3287645

For More Information:

Target Audience: Dialysis organizations

COVID-19: Nurses Call — May 21

Thursdays from 3 to 3:30 pm ET

These calls provide targeted updates on the agency’s latest COVID-19 guidance. Leaders in the field also share best practices. There is an opportunity to ask questions if time allows.

To Participate on May 21:

  • Conference lines are limited; we encourage you to join via audio webcast
  • Or, call 833-614-0820; Access Passcode: 2874976

For More Information:

Target Audience: Nurses

COVID-19: Office Hours Call — May 21

Tuesdays and Thursdays from 5 to 6 pm ET

Hospitals, health systems, and providers: Ask CMS questions about our temporary actions that empower you to:

  • Increase hospital capacity – CMS Hospitals Without Walls
  • Rapidly expand the health care workforce
  • Put patients over paperwork
  • Promote telehealth

To Participate on May 21:

  • Conference lines are limited; we encourage you to join via audio webcast
  • Or, call 833-614-0820; Access Passcode: 9984433

For More Information:

Target Audience: Physicians and other clinicians

COVID-19: Lessons from the Front Lines Call — May 22

Fridays from 12:30 to 2 pm ET

These weekly calls are a joint effort between CMS Administrator Seema Verma, Food and Drug Administration Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians: Share your experience, ideas, strategies, and insights related to your COVID-19 response. There is an opportunity to ask questions.

To Participate on May 22:

  • Conference lines are limited; we encourage you to join via audio webcast
  • Or, call 877-251-0301; Access Code: 6086125

For More Information:

Target Audience: Physicians and other clinicians

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This morning, Pennsylvania Department of Human Services Secretary, Teresa Miller, shared the following Office of Long-Term Living announcement:

Office of Long-Term Living Deputy Secretary Kevin Hancock’s last day at DHS will be Friday, June 12. Kevin has been an incredible leader and advocate at DHS, overseeing a major system transformation through the successful implementation of Community HealthChoices. CHC is both modernizing service delivery for people who rely on Medicaid for long-term services and supports and making the system more sustainable by creating more opportunity for innovation. This program’s initial successes are a testament to Kevin’s leadership and the dedication and skill of the entire OLTL team. CHC is a true success story, and I want to thank Kevin for everything he did to make this possible.

Jamie Buchenauer, who currently serves as Director of the Bureau of Fee-for-Service Programs in the Office of Medical Assistance Programs, will move into OLTL’s Deputy Secretary role on Monday, June 15. Jamie has held this position since August 2015 and has held numerous roles in state government at the Department of Health, the Pennsylvania Higher Education Assistance Agency, and the General Assembly and outside state government with the Hospital and Healthsystem Association of Pennsylvania and the Pennsylvania Chapter of the National Association of Social Workers.

Jamie brings a diverse experience both with DHS and other areas of health policy, and I am confident that she will continue to build on the strong foundation built by Kevin and the OLTL team.

I hope you will join me in welcoming Jamie to this new role and wishing Kevin luck!

Teresa

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The Department of Human Services (DHS) has released an FAQ/guidance on ACT 18 fingerprinting standards. The Act provides for a temporary suspension for the FBI Fingerprinting requirements in the Child Protective Services Law (CPSL).

The act covers both new and existing employees; however, RCPA strongly advises reviewing these standards with your leadership and Human Resources professionals, as they do not cover all positions required to obtain fingerprints, including new school employees. Additionally, there are stipulated requirements for obtaining fingerprints if you live in geographic regions with open Identogo fingerprinting sites, employee file documentation guidelines, as well as timeframes for the relief period.

To view the Act 18 guidance and FAQ, use this link. The document was created by DHS to provide guidance on Act 18 of 2020 and fingerprinting during the COVID-19 pandemic. This document is also available on the DHS website. If you have additional questions, please contact RCPA Children’s Division Director Jim Sharp.

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ODP Announcement 20-057 provides an updated timeline of target dates for completion of the Health Risk Screening Tool. Due to many additional responsibilities related to the COVID-19 pandemic, ODP has modified the guidance outlined in the HRST Protocol.

The timeline for providers to complete all HRST screenings has been extended to December 31, 2020. With the extended timeline, ODP will not redefine the phases for completion related to the individual’s Needs Level as included in the original protocol. Providers will determine the order in which the remaining screenings will be completed by December 31, 2020.

Clinical Reviewer Trainings and Advanced Rater Trainings will be provided periodically in a live, online format by HRS, Inc. Additionally, HRS, Inc has online training resources for providers.

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ODP Announcement 20-050 provides guidance to Licensed Providers of 55 Pa. Code Chapter 6400 (Residential Habilitation), Chapter 6500 (Life Sharing), and Private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IDs) regarding the process for requesting Personal Protective Equipment (PPE) for ODP licensed facilities from the PA Department of Health (DOH).

Information contained in this guidance is only for congregate care settings licensed by The Office of Developmental Programs (ODP) and not for other provider types. The Pennsylvania DOH has requested that all critical needs for ODP licensed facilities are first screened by ODP to ensure that facilities are adhering to current guidance and PPE conservation strategies before forwarding to the PA DOH. The PA DOH has a very limited supply of PPE and is triaging needs daily.

Questions about this announcement can be directed to Doug Trahey, ODP Emergency Preparedness Coordinator. As COVID-19 is a rapidly evolving situation, any guidance regarding PPE requests is subject to change. Please check the Pennsylvania Department of Health website for updates and additional information.

Attachments:

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Today, May 13, 2020, the Frequently Asked Questions Document was updated and question #46 may be of great interest to our members who have PPP loans of under 2 million.

The Small Business Administration (SBA), in consultation with the Department of the Treasury, intends to provide timely additional guidance to address borrower and lender questions concerning the implementation of the Paycheck Protection Program (PPP), established by section 1102 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act or the Act). This document will be updated on a regular basis.

Borrowers and lenders may rely on the guidance provided in this document as SBA’s interpretation of the CARES Act and of the Paycheck Protection Program Interim Final Rules (“PPP Interim Final Rules”) (link). The U.S. government will not challenge lender PPP actions that conform to this guidance,1 and to the PPP Interim Final Rules and any subsequent rulemaking in effect at the time.

  1. Question: How will SBA review borrowers’ required good-faith certification concerning the necessity of their loan request?

Answer: When submitting a PPP application, all borrowers must certify in good faith that “[current economic uncertainty makes this loan request necessary to support the ongoing operations of the Applicant.” SBA, in consultation with the Department of the Treasury, has determined that the following safe harbor will apply to SBA’s review of PPP loans with respect to this issue: Any borrower that, together with its affiliates,20 received PPP loans with an original principal amount of less than $2 million will be deemed to have made the required certification concerning the necessity of the loan request in good faith.

SBA has determined that this safe harbor is appropriate because borrowers with loans below this threshold are generally less likely to have had access to adequate sources of liquidity in the current economic environment than borrowers that obtained larger loans. This safe harbor will also promote economic certainty as PPP borrowers with more limited resources endeavor to retain and rehire employees. In addition, given the large volume of PPP loans, this approach will enable SBA to conserve its finite audit resources and focus its reviews on larger loans, where the compliance effort may yield higher returns.

Importantly, borrowers with loans greater than $2 million that do not satisfy this safe harbor may still have an adequate basis for making the required good-faith certification, based on their individual circumstances in light of the language of the certification and SBA guidance. SBA has previously stated that all PPP loans in excess of $2 million, and other PPP loans as appropriate, will be subject to review by SBA for compliance with program requirements set forth in the PPP Interim Final Rules and in the Borrower Application Form. If SBA determines in the course of its review that a borrower lacked an adequate basis for the required certification concerning the necessity of the loan request, SBA will seek repayment of the outstanding PPP loan balance and will inform the lender that the borrower is not eligible for loan forgiveness. If the borrower repays the loan after receiving notification from SBA, SBA will not pursue administrative enforcement or referrals to other agencies based on its determination with respect to the certification concerning necessity of the loan request. SBA’s determination concerning the certification regarding the necessity of the loan request will not affect SBA’s loan guarantee.21

20 For purposes of this safe harbor, a borrower must include its affiliates to the extent required under the interim final rule on affiliates, 85 FR 20817 (April 15, 2020).

21 Question 46 published May 13, 2020

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