Rural Caucus
office of the governor of the commonwealth of virginia
Slide 1
office of the governor of the commonwealth of virginia
GOVERNOR’S COVID-19 LONG-TERM CARE TASK FORCE
Dr. Laurie Forlano, Deputy Commissioner of Population Health, VDHGena Berger, Chief Deputy Commissioner, DSS
August 6, 2020
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 2
Welcome and Housekeeping Items• Please mute your phone (do NOT put us on hold) if you are not
speaking• We prefer to take questions/comments at the end of each agenda
item • Feel free to utilize the chat box
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 3
Overview of Agenda• Task Force Recap• Personal Protective Equipment Update• Testing Update
• Antigen Testing Recommendations• Financing Review• Visitation Guidelines Recap• Discussion• Next Steps
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 4
COVID-19 Cases in LTCFs and Non-LTCFs Over Time
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 5
COVID-19 Outbreaks in LTCFs and Non-LTCFs by Date VDH Notified
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 6
Number and Region of LTCF COVID-19 Outbreaks by Data VDH Notified
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 7
First COVID-19 case identified in
Virginia
7
12
Mar 1 Mar 31Mar 15
First COVID-19 death reported in
Virginia
14
First statewide webinar for ALFs
20
Timeline of Notable Events: March 2020
Governor declares State of
Emergency
17
First LTCF outbreaks
reported in Northern and
Central RegionsFirst statewide webinar for
nursing homes
28
First LTCF outbreak reported in Eastern Region
First LTCF outbreak reported
in Northwest Region
30
4
First statewide webinar about COVID-19 in healthcare facilities
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 8
First LTCF outbreak reported
in Southwest Region
3
10
Apr 1 Apr 30Apr 15
Timeline of Notable Events: April 2020
Virginia COVID-19 LTC
Task Force established
CDC begins tele-ICAR project
with Virginia nursing homes
30
17
Governor signs Executive Order
Fifty-Seven
VDH Testing Team begins support for PPS
testing in LTCFs
First MRC deployment to support LTCFs
21
23
VANG conducts first PPS testing in
LTCF
12
Task Force Kickoff Meeting
16
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 9
VDH releases COVID-19 Interim
Guidance for LTCFs
1
May 1 May 31May 15
CDC completes tele-ICAR project
with Virginia nursing homes
18
14
VDH releases Planning for PPS in
LTCFs
Timeline of Notable Events: May 2020
8
VDH releases COVID-19 LTCF Task
Force Playbook
CMS requires nursing homes to report data
in NHSN
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 10
VDH releases Nursing Home
Reopening Guidance
18
Jun 1 Jun 31Jun 15
Timeline of Notable Events: June 2020VDSS releases ALF Reopening
Guidance
23
19
Governor announces $246
million support for LTCFs
24
HHS begins onsite IPCA visits in Virginia LTCFs
LTCF outbreaks posted on LTC
Task Force website
VANG begins calling all SNFs/ALFs with outbreaks
to offer baseline PPS
8
Reopening guidance
briefing with LTC
associations
Reopening guidance briefing with LHDs
Reopening guidance briefing with LTC
associations
26
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 11
Jul 1 Jul 30Jul 15
24
HHS completes onsite IPCA visits in Virginia LTCFs
VANG ends support for PPS testing in LTCFs
2313
Reopening guidance briefing with LHDs
8
Reopening guidance briefing
with DARS
27
Reopening guidance
briefing with LTC
associations
17
VDH updates Nursing Home
Reopening Guidance
VDH updates
LTCF Playbook
10
1
Reopening guidance briefing with LHDs
Reopening guidance briefing with LTC
associations
Timeline of Notable Events: July 2020
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 12
Long-Term Care Facility PPS’: Between 4/21 & 7/21
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 13
PPS Results
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 14
Phased Reopening: Nursing Home StatusNumber of New LTCF Outbreaks Reported to VDH in the Last 7 Days (August 5)
● Central Region: 1● Eastern Region: 2 ● Northern Region: 0● Northwest Region: 0● Southwest Region: 1
Statewide (August 5) ● Nursing homes in Phase I: 89● Nursing homes in Phase II: 36
Note these data are not being posted publicly; for internal situational awareness.Data are considered incomplete, as nursing homes are not required to report phase changes.
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 15
Personal Protective Equipment (PPE) Update
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 16
Testing UpdateAntigen Testing
Shaina Bernard, PharmD
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 17
Viral Diagnostic TestsM
olec
ular
Ant
igen
Detects nucleic acid from the SARS-CoV-2 viral RNA
Detect the presence of SARS-CoV-2 antigen
Test performed at point of care (POC)
Test performed at moderate/high complexity lab
Many authorized by FDA
4 authorized by FDA
Abbott ID Now*Sensitivity: 94.7%Specificity: 98.6%
Test performed at point of care (POC)
Test performed at moderate/high complexity lab
2 authorized by FDA
2 authorized by FDA
Sofia 2 SARS Antigen* Sensitivity: 80%Specificity: 100%BD Antigen Test*Sensitivity: 85%Specificity: 100%
*Taken from assay’s IFU
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 18
Point-of-Care Antigen Testing Key Points➔ Antigen tests are known to be less sensitive than molecular tests
◆ Amount of antigen in a sample may decrease as the duration of illness increases ◆ Negative results, from patients with symptom onset beyond five days, should be treated
as presumptive and confirmation with a molecular assay, if necessary, for patient management, may be performed
➔ Nursing homes performing POC tests must have an active CLIA Certificate of Waiver◆ More information can be found on the VDH Office of Licensure and Certification website
➔ Nursing homes that perform POC tests will be responsible for reporting results to public health◆ VDH is creating a portal specifically for these results to lessen the burden
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 19
VDH NH Antigen Testing GuidancePhase Testing Scenario Testing Technology Recommended
I Initial baseline testing of all residents and staff with repeat testing of all residents and all staff, ideally within a week. Weekly testing can stop after 14 days of no new positive cases.
Initial baseline testing can be molecular or antigen. Repeat weekly^ testing should be molecular*.
I, II, III Testing symptomatic residents or staff. Molecular; Depending on known TAT of molecular tests, a rapid antigen test could be used. Negative antigen results should be confirmed by a molecular test, especially when symptom onset is greater than five days prior.
I Testing all staff and all residents in response to a positive staff member or NH-onset case (first round) with repeat testing of all residents and all staff, ideally within a week. Weekly testing can stop after 14 days (two rounds) of no new positive cases.
First round of testing can be molecular or antigen. Repeat weekly^ testing should be molecular*.
I, II, III Testing close contacts in response to a non-NH onset case. If additional cases are found, repeat testing of all staff and all residents, ideally within a week. Weekly testing can stop after 14 days (two rounds) of no new positive cases.
Molecular or antigen; negative antigen results should be confirmed by a molecular test. If additional cases are found, the first round of testing can be molecular or antigen. Repeat weekly^ testing should be molecular*.
II, III Testing close contacts in response to identification of a staff case with repeat testing of close contacts, ideally within a week. Weekly testing can stop after 14 days (two rounds) of no new positive cases.
First round of testing can be molecular or antigen. Repeat weekly testing should be molecular*.
^If an antigen test is performed for the first round of testing, the second round of testing by a molecular test can occur 3-7 days after. Waiting a week to confirm a negative antigen test result may not be warranted.*Repeat testing by molecular methods would confirm negative findings from the first round of antigen testing.
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 20
Financing Update-Eligible CostsFunding can be used for COVID-19 related costs associated with:
● Testing● Employee wages, overtime pay, and bonuses, ● Employee benefits, ● Contracted services expense,● Employee child care costs, if applicable,● Employee isolation housing, if applicable,● Costs related to screening visitors,● Personal protective equipment and supply costs,● Cleaning and housekeeping supplies, ● Telehealth costs, ● Resident transfer costs, and● Other COVID-19-related expenditures.
Payments will be based on demonstrated / invoiced COVID-19 costs only.● Detailed invoicing instructions will be provided in August.
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 21
Financing Update-Payment AmountsNursing Facilities will be eligible for a maximum payment calculated based on the following criteria:
● $27 per resident per day (less $20 Medicaid payment where appropriate)● $80 per resident per day during outbreaks● Additional support for periodic testing● Less payments received from Provider Relief Fund
Assisted Living Facilities will be eligible for a maximum payment calculated based on the following criteria:
● A facility-based payment of up to $4,000 for each assisted living facility each month (July, August, September, & October)
● An additional daily payment for four months to each assisted living facility based on the number of auxiliary grant (AG) recipients residing in the facility
○ This additional payment equivalent to $15.00 per AG resident per day
Initial communication from DMAS to providers will provide additional detail on maximum payment formula.
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 22
Financing Update-Draft Schedule for CARES Act PaymentsJuly 1, 2020 Eligible costs begin date. Nursing facilities and assisted living facilities should make sure they are documenting their COVID-19 related costs for future invoicing.Week of July 27th DMAS awards administrative support contract. DMAS will contract with an external vendor to support communication with recipients, receipt of invoices, and review and audit of submissions.Early August DMAS or Admin Vendor will send communications to nursing facilities and assisted living outlining the process for submission and necessary documentation, with enrollment, invoice and cost reporting/reconciliation forms.Mid-August Invoices Start Being Accepted / Facilities Enroll for Payment. Facilities can submit invoices and necessary support documentation for costs incurred during July, 2020. Facilities will also have to document funds received from the Provider Relief Fund and DMAS's $20 per diem increase to calculate allowable expenses. Facilities will also have to submit required documentation for enrollment to be paid under this program. Please note, even if a nursing facility is already enrolled as a Medicaid provider, they will have to enroll separately to be paid under this CRF-funded program.
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 23
Financing Update-Draft Schedule ContinuedLate August / Early September DMAS begins making payments. DMAS will process payments on a rolling basis every two weeks following the initial submissions as they are processed by the support vendor.
October 31, 2020 Eligible costs end date. Facilities should submit no costs incurred after October 31 for reimbursement. DMAS and vendor will not accept documentation for costs incurred after this date.
December 1 Final documentation due.
Late December / Early January DMAS makes final payments.
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 24
Visitation Guidelines Recap● When in Nursing Home Reopening Phases I and II, VDH generally recommends against
face to face visitation except for compassionate care situations. ● Additional visitation practices, such as window visits and outside visits, are allowed if
facilities ensure social distancing and universal source control practices are adhered to.● When in Nursing Home Reopening Phase III, VDH recommends screening and additional
precautions including social distancing, hand hygiene (e.g., use alcohol-based hand rub upon entry), and the wearing of cloth face coverings or facemasks prior to allowing face to face visitation.
● Visitation policies are at the discretion of each facility based on phased reopening status and capacity for implementation of social distancing and universal source control practices.
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 25
Discussion
Rural Caucus
office of the governor of the commonwealth of virginia
Slide 26
Next steps• Testing, Staffing, and Visitation Best Practices
Webinars