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

October 1, 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• Data Update • Testing Update• Updated Reopening Guidance• COVID-19 Vaccine Planning Update• 2020 General Assembly August Special Session Update• Long-Term Care Wellness Advisory Committee Update • Visitation Working Group Update• 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 Long-Term Care Facilities*^

March 17, 2020 – September 21, 2020

5

Month Number of outbreaks

Average number of cases per outbreak†

Average number of deaths per outbreak†

March 2020 16 47 9

April 2020 98 47 9

May 2020 49 29 4

June 2020 31 22 3

July 2020 58 22 2

August 2020 57 16 1

September 2020 21 11 1

*Long-term care facility includes assisted living facilities, multicare facilities, and nursing homes; ^Data from VOSS and VEDSS are subject to change; †Averages are rounded to the nearest whole number

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 6

LTCF COVID-19 Outbreaks by Month

6

Virginia Long-Term Care Task Force Convened (4/10)

CMS Reopening Recommendations (5/18)CMS Reporting Requirement (5/24)

CMS Testing Requirements (8/25)

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 7

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 8

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 9

NHSN Updates● New POC reporting pathway will be released on October 15, 2020● Nursing homes with NHSN SAMS Level 1 access will need to upgrade to

Level 3 access○ More information: https://www.cdc.gov/nhsn/ltc/covid19/sams-access.html ○ Look out for an email invitation from the CDC○ Any facility that would like to upgrade now can email nhsn@cdc.gov with the subject

line “Enhancing Data Security”○ HQI available to provide technical assistance

● Weekly healthcare personnel flu vaccination reporting available● COVID-19 vaccination reporting in development● 84 nursing homes still need to confer rights to VDH

○ Email hai@vdh.virginia.gov for assistance

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 10

Testing Advisory Group Update

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 11

Antigen Testing Training Tools

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 12

Updated Nursing Home Reopening Guidance

● Per updated CMS guidance for nursing homes on testing and visitation, all references to nursing home reopening phases are being retired

● Facilities should follow CMS guidance○ VDH guidance is being revised

● Nursing homes will no longer be asked to submit phase change attestation forms ○ REDCap project being retired

● VDH will be posting percent positivity data by locality (city, county)○ Facilities can use VDH or CMS data; must document data source and

use consistently● Working with DSS to align ALF guidance

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 13

COVID-19 Vaccination Planning: Recent Updates

• Updating Virginia COVID-19 Vaccination Plan – Draft 2• Vaccination (Flu, Routine) Communications Campaign• State Table Top Exercise Set for October 8 (Workshop) and

14 (Table Top)• ACIP Meeting• VIIS Guidance• Vaccine Advisory Workgroup Updates

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 14

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 15

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 16

The Virginia COVID-19 Vaccination Plan

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 17

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 18

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 19

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 20

ACIP Meeting – September 22, 2020

ACIP COVID-19 Vaccines Work Group UpdatePhase III trials ❑ Moderna: enrolled 25,296 participants as of 9/16/2020

❑ 28% of participants are enrolled from “diverse communities” ❑ Pfizer: enrolled 31,928 participants as of 9/21/2020

❑ 26% of participants are from “diverse backgrounds”

ACIP Work Group will conduct an independent review of safety and efficacy data

If/when FDA decision is announced, ACIP will hold an “emergency” meeting with public comment session, and then will vote on recommendations for vaccine and populations for use.

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 21

ACIP Meeting – September 22, 2020 ContinuedNew Vaccine Safety Mechanisms❑ New Monitoring ACIP COVID-19 Vaccine Safety Technical (VaST) Subgroup

❑ Specifically dedicated to COVID-19 vaccine safety ❑ Will track “adverse events of special interest (AESI):

❑ general adverse events, ❑ adverse events that are vaccine-specific (mRNA, viral vector, adjuvanted, etc.), and ❑ population-specific adverse events (children, pregnant women, co-morbidities, elderly,

etc.)❑ A new system, V-SAFE, will provide enhanced safety monitoring for COVID-19 vaccine for essential

workers in early phase vaccination ❑ V-SAFE will do smartphone-based text, text-to-web survey, email-to-web survey for early vaccine

recipients and will send daily check-in messages for 1 week post-vaccination, and then weekly check-in messages for 6 weeks post-vaccination

❑ V-SAFE will use contact information from COVID-19 vaccination registration for essential workers (uncertain where registration data will come from).

❑ From V-SAFE, any adverse events will then be reported to VAERS

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 22

ACIP Meeting – September 22, 2020 ContinuedOverview of WHO, Johns Hopkins University, and National Academies of Science, Engineering, and Medicine (NASEM) Prioritization Frameworks

Phase 1 Allocation COVID-19 vaccine: Work Group Considerations – Possible Groups❑ Phase 1a: Healthcare personnel (~20 million)

❑ Phase 1b: ❑ Essential Workers (not HCP) (~60 mill) ❑ High Risk Medical Conditions (>100 mill) ❑ Adults >65 yo (~53 mill)

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 23

COVID-19 Vaccine Training

Dry Ice Safety and Vaccine Storage Video and Job Aid Completed

Other Planned Training❑ Vaccine Provider Enrollment❑ Non-VDH vaccinator ❑ VAERS Reporting❑ Vaccine Ordering❑ Doses Administered Reporting❑ Point of Dispensing Essentials

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 24

VIIS Onboarding Documentshttps://www.vdh.virginia.gov/content/uploads/sites/11/2020/09/VIISOnboardingToolKit.pdf

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 25

Virginia Vaccine Advisory Workgroup

❑Charter and Structure

❑Member Listing – 66 members

❑Tentative Timeline and Responsibility

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 26

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 27

COVID-19 Vaccine Priority Groups – Data Collection Effort

Data Collection Tool Provided to LHDs❑ Health Districts need to identify critical occupational groups in each jurisdiction, and

ensure relationships and plans are in place ❑ Spreadsheet for the LHDs to complete and return to the Regional Emergency Coordinators

by Sep 28❑ Regional Emergency Coordinators will consolidate and provide to Mike Magner/Jonathan

Kiser by Oct 7❑ State level we are collecting data from:

❑ Hospitals❑ Virginia Department of Corrections, ❑ Virginia Department of Behavioral Health and Disabilities Services, ❑ Dominion Resources❑ Assisted Living Facilities❑ Skilled Nursing Facilities❑ Colleges/Universities

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 28

CDC Digital Media Toolkit: 2020-21 Flu Seasonhttps://www.cdc.gov/flu/resource-center/toolkit/index.htm

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 29

2020 August Special Session Update: Budget Language● Senate Finance & Appropriations Committee

○ 299 #1s: Provides for residents and employees of nursing facilities or assisted living facilities to have priority in testing for COVID-19 to help prevent or contain outbreaks. Testing shall be provided, as needed, by DCLS or other public health testing agencies and any testing costs through the public health system for employees or residents of nursing homes or assisted living facilities may be billed to responsible third-parties.

○ 313 #3s: Directs DMAS to modify CARES Act funding disbursement methodology to define eligible costs for reimbursement as COVID-related costs incurred since March 12, 2020 or as far back as the CARES Act allows.

○ 313 #13s: Adds $11.2 million from the general fund and $11.2 million in matching federal Medicaid funds to extend the $20 per day add-on to Medicaid nursing and specialized care facility rates to June 30, 2021.

● House Appropriations Committee○ 299 #2h: Directs the VDH to convene a work group to examine and develop a plan to ensure that vaccines and

other medications to treat or prevent the spread of COVID-19 are equitably distributed.○ 299 #3h: Directs VDH to review and update data collection and reporting protocols for COVID-19 or other

infectious disease data to only report actual deaths not an extrapolated projection of deaths.○ 300 #1h: Requires medical facilities licensed by the VDH to allow patients with disabilities to be accompanied by a

designated support person at the time health care services are provided and to allow for visits by such person(s).○ 313 #1h: Adds $11.2 million from the general fund and $11.2 million in matching federal Medicaid funds to extend

the $20 per day add-on to Medicaid nursing and specialized care facility rates until March 31, 2021.

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 30

LTC Wellness Advisory Committee Update● Kickoff meeting held September 18, 2020

● Scope limited to nursing homes and assisted living facilities

● 6 Workgroups○ Focus on current landscape in Virginia, crisis support, employee

wellness, education/training, policy, and funding

● Standing monthly meeting 2nd Friday of each month; next meeting is October 9, 2020 at 1:00 PM

● Please contact angela.spleen@vdh.virginia.gov to become a member or provide feedback

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 31

Visitation Working Group Update

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 32

Discussion

Rural Caucus

office of the governor of the commonwealth of virginia

Slide 33

Next steps