safe and calm june 10, 2020€¦ · *adequate facilities, workforce, viral testing phase iii...
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LeadingAge MichiganSafe and Calm June 10, 2020
Copyright 20092
Safe and Calm Agenda 6/3/2020
Situation Update for US and Michigan
Nursing Home and AFC/HFA Testing and Reporting
Situation Update
CDC/CMS/Executive Orders
Testing and Reporting
Practice and Guidelines
Advocacy LeadingAge Michigan Advocacy Update
LeadingAge Michigan AdvocacyJune 10, 2020
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Executive Order and Clarity
• Yesterday we formally submitted a letter to MDHHS Director Robert Gordon
• in the letter we asked that they take a look at issues surrounding
• EO 108 – Independent Living
• EO 112 – Non-Certified employees
• EO 95 – Communal Dining
Executive Order and Clarity • EO 108 – Independent Living
• We asked for clarity around independent living, visitation and the rescinding of the stay at home order.
• The state is in very early stages of drafting formal visitation guidance for HFAs
• EO 112 – Non-certified staff• We ask that the department consider allowing
SNFs to continue the use of non-certified staff.
• EO 95 – Communal dinning • Asked for guidance on the definition of
communal dining and for clarity around what communal dining means in each level of care.
SB 690 – CARES Act spending• State has $3 billion in one time CARES act
funds to spend on COVID related costs• Currently under the Governors sole discretion
until June 30th
• The House and the governor are currently negotiating how to allocate these funds
• It is likely a bill in some form is passed• It will have to go back to the senate for
approval
• Right now the goal of the legislature is to allocate the whole fund
• The bill currently spends $1.264 Billion of the fund
SB 690 – Direct Care Worker PaymentsThe $3 dollar an hour increase is currently one of the topics the House and the Governor are debating
• Centers around the level of funding that should be provided
As it stands Direct care workers would receive a $3 dollar an hour bonus payment retroactive to April 1st, 2020 and go through September 30th, 2020
• These funds are inclusive of costs to the employer• The employer needs to take out their costs before they are
distributed to employees (i.e. payroll taxes)
• A “direct care worker" means• registered nurse• licensed practical nurse, • competency-evaluated nursing assistant• respiratory therapist
• Employed or contracted by skilled nursing facility or an area agency on aging
• Those who previously received the $2 an hour bonus payment will receive an extra $1
SB 690 PPE Grant Funding• Establishes $50 Million dollar Grant Funding for
PPE reimbursement for PPE and testing costs • Providers who can receive these funds have
been limited to • Long-term care facilities.• Dialysis facilities.• Outpatient facilities collecting diagnostic respiratory specimens.• Dental facilities.• Other outpatient facilities.• Home healthcare.• Long-term acute care hospitals.• Emergency medical service providers.• Rural pharmacies.• Funeral directors and mortuary services.• Residential congregate facilities.
• These terms are not currently defined in the bill
• We have had and are having discussions with policy makers to reprioritize the list, add to the funding pool and have provided them with friendly definitions
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Senate Bill 77 - Electronic Monitoring
• The bill is going to be taken up and passed tomorrow
• Allows a resident or their representative to install electronic monitoring equipment in their room
• Paid for by the resident• Protects the privacy of others in the nursing
home to the best extent possible• Must get consent of a roommate is applicable• Roommate can recall their consent at any time.
• Notice must be posted
• Evidence is admissible in civil or criminal court cases
SB 77 Provider Responsibilities• Reasonable accommodation
• A place to mount the recording device• Access to a power source• Notify residents that they can install a
camera
• Can ask that residents or Representatives provide the request in writing
• Cannot refuse an admission or remove a resident because of the request to install a device.
SB 77 Electronic Monitoring
In late January, our testimony highlighted • Resident Rights concerns
• Decision Making• Resident Privacy (Roommates)
• HIPAA compliance• Renewal Period• Asked for the establishment of an
implementation workgroup
SB 77 Electronic Monitoring • The bill is going to be taken up and
passed tomorrow• Politically the Senate does not want to
be seen as sitting on a bill after the abuse video
• Debate is intentionally being moved to the house were changes are expected.
• How do members feel about the potential of residents installing their own electronic monitoring equipment in their room?
• 1 represents uncomfortable and 5 represents comfortable
HUD – CARES Act Funds
• On June 4th, Katie Sloan to Secretary of HUD Ben Carson
• The Letter calls for HUD to release the remaining CARES act funds• $200 million for Section 8 • $50 million for Section 202 Housing• $10 million for service coordinators
• The funds where issued in late March so they are well overdue
• We are in the process of forwarding the letter to all members of Michigan's national delegation to hopefully provide some relief to our HUD providers
SB 956 – COVID in SNFsThe bill that disallows nursing homes for caring for or admitting COVID positive individuals
Bill is currently being held up in committee
• Very political
Department is in the middle of discussion regarding the feasibility of the bill because of the Senate Oversight Committee
We are monitoring the bill for now
Thank You To Our Exhibitors!
Furnishings By Design, LLC
Fusco, Shaffer & Pappas, Inc.
Genesis Rehabilitation Services
GMB Architecture & Engineering
HealthPRO Heritage
Hoekstra Transportation
HomeTown Pharmacy LTC
Hooker DeJong, Inc.
HPS
HPSI
In Touch Pharmaceuticals
360careAdvanced Satellite Communications, Inc.All Med Medical Supply, LLCBaker TillyBasic American Medical ProductsCompass Communications Group,Concept Rehab, Inc.Creative Dining ServicesDermaRite IndustriesEZ Way, Inc.FOX RehabilitationFunctional Pathways
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Situation Update
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US and Michigan
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World Situation Summary
Coronavirus Cases
7,275,409
Deaths 411,871 (11% closed)
Recovered 3,376,309
Active Cases 3,487,229
Mild 3,433,313 89
Serious 53,916
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June 9 , 2020
0-1K 1-5K 5-10K 10-20K 20-40K 40+K
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June 9, 2020 US Cases by Day
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April 10 – June 9
0.00
200.00
400.00
600.00
800.00
1000.00
1200.00
1400.00
1600.00
Seven Day Rolling Average for New COVID Cases for Past 60 Days
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April 10 – June 9
0.00
20.00
40.00
60.00
80.00
100.00
120.00
140.00
160.00
Seven Day Rolling Average Daily New Deaths for Past 60 Days
Testing and ReportingJune 10, 2020
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MDHHS Testing/Reporting Workgroup
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• McKenzie/MSU contacts for data validation almost completed
• 99% of facilities reporting now that closed facilities deleted
• Data will still differ from NHC
• Plan to post FAQs and will publish a report of data validation findings
• Staffing – anticipate that some nursing homes will continue to cover positive
tested staff. Identified a large staffing agency that may help. Considering a
template contract/rates. Would cover all types of long term care needs, not
just nursing homes
• Testing – National Guard completing final 25 counties
• Working and considering next steps
June 7 Updates to MDHHS Reporting
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• Confirmed and probable cases now reported
separately by age group, gender, and race for
state, regions, and counties
• Serologic (antibody tests) separated from
diagnostic tests
• Cumulative confirmed cases and deaths by date
• Definition of probable cases
• Clinical disease and epidemiologic link
• Presumptive lab result and clinical disease or link
• Death certificate that lists COVID as cause of death
without positive lab result
https://www.michigan.gov/Coronavirus
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Tests by County9-10%
Tests per 100,000
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152 Michigan Infection Control Surveys Posted
QSO 20-29-NH
NHSN Weekly Reporting/NHC
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• Suspected and confirmed COVID cases, including those previously treated for residents and staff
• Total deaths among residents and staff• PPE and hand hygiene supplies• Ventilator Capacity• Resident Beds and Census• Access to COVID 19 testing• Staffing Shortages
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NHC Survey Reporting
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• As of 5/31/2020 – 368/442 onsite surveys
• 150 surveys reported – from front landing page
• 9 cases where infection control cited
• Wide range of citations – abuse and neglect, reporting
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Practice and Guidelines
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Reopening/Phase IIGating Criteria: Downward trajectory of flu and covid like illness
(symptoms) in 14 day period
Downward trajectory of cases over 14 days or + test/total tests (14d)
Hospitals treating all patients without crisis care and robust testing program in place for at risk healthcare workers, including antibody testing
Core State Preparedness
Testing and Contact Tracing
Healthcare System Capacity
Protection of workers and those living in
high risk facilities (LTC)
Protection of users of transit systems
https://www.cms.gov/files/document/covid-recommendations-reopening-facilities-provide-non-emergent-care.pdf
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All phases – continued hygiene, recommend masks in public and on mass transitAnyone ill must stay homeEmployer policies for social distancing, protective equipment, screening and temp checks, disinfection
Phase I - Vulnerable must shelter in place, avoid more than groups of 10, minimize non essential travel, encourage telework, close common areas, senior care visits prohibited, elective surgeries can resume, public under restrictions
Phase II – States and regions with no evidence of a rebound that satisfy the Gating Criteria
*Optimization of telehealth services/minimize in person services*Those at higher risk should continue to shelter in place*Non-emergent care in regions with lower levels of COVID*Adequate facilities, workforce, viral testing
Phase III – Vulnerable practice social distancing, low risk minimum time in crowded environments, unrestricted staffing of worksites. Senior care visits and hospital visits can resume; large venues with social distancing, bars with increased standing room
General Reopening Considerations
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Preserving capacity for surges of COVID and rapid deployment of alternate care sites/metricsPrioritize services likely to deter harmPrioritize at risk populations
Facility Reopening ConsiderationsSegregated non-covid screening areas- separate from COVID areasSufficient resources across continuum/PPETracking patient outcomes Dedicated COVID spaceMinimized visitation/screening
Testing Considerations
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Procedures – viral testing 24 hours prior or self isolate 14 daysCOVID care zones for positive persons receiving emergent careStaff screening in non covid areasExclude visitors if do not pass the screen, especially from non covid zonesTesting results reported to state health department
PPE/Supply Considerations
Staff to wear surgical masks at all times, unless higher level neededN95/shields for oral/respiratory proceduresPatients and visitors wear cloth face coveringsConserve PPE using CDC strategies
Workforce Considerations
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Sufficient to respond quickly to augment covid care as neededRoutine staff screening/No staff crossoversUse CDC return to work guidanceStaffing levels in community must be adequate to cover a potential surge
Sanitation Considerations
Established plans for cleaning and disinfection prior to using spaces for non covid careThorough decontamination of equipment
Patient guide in Englishhttps://cms.gov/files/document/covid-what-patients-should-know-about-seeking-health-care.pdf and in Spanish here: https://www.cms.gov/files/document/covid-what-patients-should-know-about-seeking-health-care-spanish.pdf
Michigan Reopening Plans
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In Progress
MLARA Workgroups now coordinating with MDHHSHigh Acuity – nursing homes – tracking CMS GuidanceMedium Acuity – assisted living levelLow Acuity (congregate settings) – eliminate most from long term care definition and provisions
CMS Recommendations for Reopening
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All state, regional, or facility specificCase status in community, Case status in nursing homes, Adequate staffing, Access to testing
Baseline, All staff weeklyWritten protocols for screeningTest processing
Universal Source ControlAccess to PPELocal Hospital Capacity
Grid – mostly visitation and activity related
Outdoor visitation
https://www.cms.gov/files/document/qso-20-30-nh.pdf-0
Thank You To Our Sponsors!
Exclusive
Gold
Silver
Bronze
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CMS Temporary Waivers – Glide Path130 Medicare Waivers
150 Medicaid Waivers
Currently reviewing claims and encounter data to determine how these flexibilities were used
Telehealth Service use – dramatic
What will become permanent?
What laws/rulemaking will be required
WHO and Asymptomatic Illness
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• WHO official states asymptomatic transmission rare
• Answer not definitive, reviewing more data
• But detailed contact tracing not found any significant spread
• Others believe that it can create 40-60% of all transmission
Executive Orders
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Date EO Title
6/5/2020 2020-114 Safeguards to protect workers
6/5/2020 2020-115 Temporary restrictions on events and gatherings
6/5/2020 2020-116 Suspension of your work permit application requirements
6/9/2020 2020-117 Childcare services for essential workforce
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2020-36: Protecting workers who stay home, stay safe when they or close contacts are sick
• prohibited from disciplining/discharging employees who stay at home when at particular risk
for infecting others
• must treat such an employee as if taking medical leave under the Paid Medical Leave Act
• prohibited from disciplining/discharging employees who failed to comply with a requirement
to document that employee or close contacts has one or more of the principal symptoms of
COVID-19
• All persons with symptoms must remain in home until three days have passed since symptoms
resolved and seven days have passed since first symptoms appeared or swabbed for testing
• Persons with close contact should remain in homes for 14 days except for health care
professionals, workers at healthcare facility, first responders, child protective services, child
care workers, workers at correctional facilities
• Workers who return to work early are not entitled to protections
• Persons with + findings, symptoms, or close contact may only leave home for essential
supplies and may engage in outdoor activities with social distancing but must wear covering
over nose and mouth
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2020-61: Temporary relief from certain restrictions and requirements governing the provision of medical services – Rescinds 2020-30
•advance practice nurses within their scope of practice; Registered nurses and licensed practice nurses may order collection for testing; LPNs may provide services within scope of practice without registered nurse supervision
•Health care facilities: may allow students in health care professionals to volunteer or work appropriate to their training and experience; medical students, PTs, EMTs, may work as respiratory therapist extenders under supervision; health care professions licensed and in good standing in other states may practice in Michigan; may use qualified volunteers or personnel from other facilities
•Any physician, PA, RN, LPN, or RT may be issued a temporary license if licensed in good standing in another country, with 5 years experience, practiced at least one year in past 5.
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2020-61: Temporary relief from certain restrictions and requirements governing the provision of medical services – Rescinds 2020-30•Any licensed health care professional or designated health care facility is not liable for injury sustained by a person by reason of providing medical services in support to response to COVID-19: includes all entities defined as healthcare facilities by the public health code
•Healthcare professionals may operate without completion of an exam if exam is unavailable, may operate without fingerprinting if unavailable, may operate without completing continuing education
•Basic life support, advanced cardiac life support, first aid certifications will remain in effect if due to expire during the emergency
•Deadlines for tele-communicators employed by primary public safety answering points are suspended until 60 days after termination of the emergency
Under Adult Foster Care act, may offer employment, contract, or clinical privileges when the facility conducts a search of public records through the internet criminal history access tool (ICHAT) and person not found to be ineligible. Fingerprinting requirements are suspended as a condition for licensure for hospitals, nursing homes, county medical care facilities, or psychiatric hospitals. (c) "Covered facility" means a health facility or agency that is a nursing home, county medical care facility, hospice, hospital that provides swing bed services, home for the aged, or
home health agency.OPEN
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Order 2020-61 temporarily suspends any law or regulation that requires continuing education for a health care professional to gain licensure or renewal of their licensure while the emergency declaration is in effect.
• Through June 9, 2020, LARA may recognize hours worked as hours toward continuing education courses or programs required for licensure. Proof of working in response to COVID-19 can be handling patient care or providing other direct support, those hours may count toward continuing education requirements as long as they were earned before June 9, 2020 at 11:59 p.m.
Reasonably sufficient evidence to show that the hours they worked from the effective date of EO 2020-13 through June 9, 2020• Examples of reasonably sufficient evidence include, but are not limited
to, a written attestation by the licensee, a Human Resources Administrator, or a direct supervisor at work to the timeframe, amount, and nature of the hours worked.
• Claiming work responding to the COVID-19 emergency as CE but does not report to a hospital, a self-attestation regarding those hours is sufficient. One hour worked responding to the COVID-19 emergency will amount to one hour of CE.
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2020-95: Enhanced protections for residents and staff of long term care facilities – Rescinds 2020-84:
All long term care facilities must use best efforts to create a dedicated unit. 80% occupancy rule eliminatedService pathways unchangedHospitals must keep residents until a safe destination is foundDecisions should be based on patient safety, safety of other residents, wishes of patient/family, and guidance from local health departmentFour provider groups covered, but only nursing homes and hospitals can transfer to hubsReporting requirements6/17/2020
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5/29/2020
2020-108:Temporary Restrictions on Health Care Facilities;
Rescinds 2020-72 but extends provisions related to visitation for all health care facilities: NH, HFA, AFC, IL
Requires all persons entering to wear a covering over the mouth and nose when indoors or within six feet.
6/26/2020
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Bureau of Professional Licensing and CEUsCEU hours to gain licensure or renewal while emergency declaration in effect – rescindedCan recognize hours spend responding to COVID through June 9, 2020 – rescinded• Patient care or support directly related to
pandemic• Earned before June 9• Audits – sufficient evidence, attestation,
human resources staff• I hour = 1 hour
4/30/2020 LARA FAQs
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• CDC Recommendations to minimize spread
• EMS and screening
• Admitting Positive COVID residents – CDC Interim Guidance for Discontinuing
Transmission Based Precautions; 72 hours without symptoms (use CDC
symptom based guidelines/dedicated unit) PPE/private room
• Use MDHHS hospital discharge algorithm
• TB testing – delayed, but screening
• Fingerprinting – look at workforce background check
• CPR flexibilities
• Training for staff rather than drills
• BFS only allegations
• Direct care workers are essential staff
PointClickCareProSure Fund, ThePS of MIReliant RehabilitationRemedi SeniorCare PharmacySelect RehabilitationService Care Industries Inc.Spartan ChemicalThe Compliance StoreTherapy Management, Inc.TMCValue FirstZiegler
Interstate Restoration
It ’s Never 2 Late, LLC
Kalamazoo Long Term Care
Pharmacy
Kingscott Associates
Marcus & Millichap
McKesson Medical Surgical
Midwest Juice, Inc.
Mobile Care Group
Omnicare
PCA Pharmacy
PharMerica
Thank You To Our Exhibitors!
