Coronavirus

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​In response to the coronavirus (COVID-19) pandemic, we are working with the federal government​​​ to ensure nursing hom​​es, assisted living communities, and intermediate care facilities for indiv​​iduals with intellectual disabilities receive necessary supplies and guidance to prevent the spread ​of this virus.​

Visit this website regularly for the latest information that AHCA/NCAL has to share with long term care providers about COVID-19. 


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How You Can Help Prevent the Spread of COVID-19

 Providers

Please note tha​t skilled nursing providers should consult the guidance put forth by CMS and the CDC, and assisted living communities should consult CDC guidance. Providers should also check their local and state health departments for updates and potentially stricter guidance, but these are general, national prevention and containment tips:

 
Infection Control: Maintain i​nfection control policies and procedures, updated where needed and increase transmission-based precautions.
 
Staff: Remind about hand hygiene and proper use of PPE. Tell them to stay home if they're sick. Screen all personnel coming into the building.
 
Limit Interactions: Implement social distancing within the facility where possible to help prevent the spread of infection.
 
PPE: Preserve your current supply if you're running low. Ask for help from local and state officials and document requests.
 
Communicate: Report suspected or confirmed cases to authorities. Keep residents, families and staff informed about your developing situation. Prepare for media inquiries.
 
Engagement: Follow government guidelines for safe in-person visitations, keep residents connected with loved ones remotely, and offer meaningful activities adapted for this situation​.


If a staff member shows symptoms of COVID-19: Have them go home immediately. 

If a resident shows symptoms of ​COVID-19​: Implement droplet precaution, and contact the local health department. ​


 Families

Coronavirus (COVID-19) poses a serious threat to older adults (especially 80 years old and older) and those with underlying health conditions. This is why in certain circumstances the federal government and many state governments are restricting visitors to nursing homes and assisted living communities. Adaptations (e.g., limited indoor and outdoor visits) and exceptions on a case-by-case basis (e.g., end-of-life or compassionate care visits) may be made. ​We understand this is difficult, but the safety and wellbeing of your loved one is our top priority.  

Here’s how you can continue to stay in touch with them, and how you can help: 

  • Communicate with your loved ones through alternative ways for the time being, whether by phone, video, social media, or other methods. Ask the facility about ways they can help with this.  
  • Make sure your loved one’s facility has your emergency contact information. The facility may need to communicate with you about any developments regarding your loved one or about the facility as a whole.
    • Many long term care facilities are only permitted to share information about a resident to a designated health representative. Work together as a family unit to share information to keep everyone informed.       
  • If you must come to the facility, coordinate with the staff ahead of time. Learn more about how you can prepare for a visit to a long term care facility
    • They may ask you some questions, take your temperature, have you take a COVID test, and/or make sure you’re wearing proper protective equipment (like a mask) when you arrive. This is to make sure you do not pose as a potential risk to residents and staff.  
    • If you are asked to not enter the building, please understand this is for the safety of your loved one and everyone else in the building. Nursing homes and assisted living communities are following direction from the government to prevent the spread of this virus.  
    • ​If you are permitted in, please wash your hands or use alcohol-based hand sanitizer immediately upon entering and throughout your visit. Wear a mask and any other protective equipment as directed by the facility. Avoid touching your loved ones or other individuals in the building. Again, we know this is difficult, but the virus is very contagious and social distancing is important at this time. ​
  • Do your part to help slow the spread of COVID-19. High community spread is linked to outbreaks in nursing homes. Follow the CDC’s recommendations to protect yourself and others. Get the COVID-19 vaccine, when you are eligible. 
  • ​Warn your loved ones about potential scammers during this crisis and encourage them to be cautious.​

 Residents

Coronavirus (COVID-19) poses a serious threat to older adults (especially 80 years old and older) and those with underlying health conditions. This is why in certain circumstances the federal government and many state governments are restricting visitors to nursing homes and assisted living communities. We understand this is a difficult and stressful time. Those who work in long term care facilities are focused on your safety and wellbeing.  

Here’s how you can continue to stay in touch with your loved ones, and how you can help: 

  • Ask the facility about other ways you can communicate with your loved ones, whether by phone, video or social media.  
  • If you haven't already, get the COVID-19 vaccine. Your facility is working with a pharmacy or state/local officials to offer vaccinations​ and can provide more specific information about how and when this will work. 
  • Follow everyday preventive actions such as: 
    • ​Washing your hands or using alcohol-based hand sanitizers 
    • Covering your cough and sneezes ​
    • Wearing a mask over your nose and mouth 
    • Keeping 6-feet distance from other residents and staff (when possible) 
  • ​Ask other individuals (including staff) to avoid touching you with handshakes, hugs or kisses. Ask them to wash their hands. Do not be shy! It’s okay to remind people.
  • Watch out for potential scammers​ during this crisis. 
  • If you begin to experience difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell​, tell a staff member immediately.​

 

 

CMS Announces Changes to 1135 Waivershttps://publish.ahcancal.org/News-and-Communications/Blog/Pages/CMS-Announces-Changes-to-1135-Waivers.aspxCMS Announces Changes to 1135 Waivers4/9/2021 4:00:00 AM<p></p><div>This week, CMS <a href="https://www.cms.gov/files/document/qso-21-17-nh.pdf" target="_blank">issued</a> a memo announcing it is ending four of the 1135 waivers issued in response to the COVID-19 Public Health Emergency (PHE). These changes are effective May 10, 2021. The four waivers that will be ending relate to prior notification of room and roommate change, prior notice of transfer/discharge, certain care planning requirements and MDS submission.  </div><div> </div><div>CMS also provides clarification and recommendations for Nurse Aide Training and Competency Evaluation Programs (NATCEPs). Currently, CMS is <strong>keeping</strong> the current nurse aide waiver. </div><div> </div><div><strong>Summary of Removed Waivers</strong> </div><div><br></div><div>CMS is making the following changes to blanket 1135 waivers, effective May 10, 2021. CMS’ rationale for removing these waivers is that facilities have developed processes for completing these requirements at this point. </div><div><br></div><div><ul><li>​Resident roommates and grouping: <span style="font-size:11pt;">​</span></li><ul><li><span style="font-size:11pt;">​Ending: waiver of notification prior to Resident Room or Roommate Change at 42 CFR §483.10(e)(6). </span></li><li><span style="font-size:11pt;"></span>Keeping: related waivers at 42 CFR 483.10(e)(5) and (7) when change of rooms is done solely for purposes of cohorting due to COVID-19.  </li><li>I<span style="font-size:11pt;">mpact: You must provide notice before a room or roommate change except when the change is solely for COVID-19 cohorting. </span></li></ul><li>R<span style="font-size:11pt;">esident transfer and discharge:</span></li><ul><li>​​​Ending: waiver of notification prior to Transfer and Discharge at 42 CFR §483.15(c)(4)(ii) </li><li>​Keeping: related waivers at 42 CFR 483.10(c)(5) as well as 483.15(c)(3), (c)(5)(i) and (iv) and (c)(9), and (d) that allow providers to transfer or discharge residents to another long term care facility solely for cohorting purposes without prior written notice.  </li><ul><li><strong>Note:</strong> It is important to <a href="https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf" target="_blank">read​</a> the details of these waivers to ensure you are applying them correctly and provide notice as soon as possible when transferring or discharging residents for cohorting purposes. </li></ul><li>Impact: You must provide written notice of transfer or discharge at least 30 days in advance, or as soon as practicable in certain situations, before the transfer or discharge. </li></ul><li>​Care planning requirements:  </li><ul><li>​Ending: waiver of certain care planning requirements at §483.21(a)(1)(i), (a)(2)(i), and (b)(2)(i) for residents transferred or discharged for cohorting purposes.  </li><li>Impact: You must complete baseline care plans within 48 hours of admission and comprehensive care plans within seven days of completion of the comprehensive assessment, according to current regulations.  </li></ul><li><span style="font-size:11pt;">​Minimum Data Set (MDS): </span></li><ul><li>​Ending: waiver of timeframe requirements for completing and transmitting resident assessment information at 42 CFR §483.20. </li><li>Keeping: waiver at 42 CFR §483.20(k) related to the Pre-Admission Screening and Annual Resident Review (PASARR). </li><li>Impact: You must complete and transmit MDS assessments according to current regulations. <br></li></ul></ul></div><div><strong><br>Additional NATCEP Information </strong></div><div> </div><div>AHCA/NCAL is pleased that CMS has recognized that time worked by the nurse aides during the PHE may count towards meeting the federal 75-hour training requirement and is encouraging states to evaluate their NATCEP to consider time worked during the PHE to help temporary nurse aides become certified nurse aides (CNA). CMS has also clarified that the four-month regulatory timeframe for completing the nurse aide training and competency evaluation requirements after hire will be reinstated when the blanket waiver ends and <strong>will start at that time</strong>. Nurse aides will have the full four-month period starting from the end of the blanket waiver to successfully complete the required training and certification, regardless of the amount of time worked during the time the waiver was in effect. Federal requirements do not specify whether training must be delivered in a classroom versus a nursing home setting, and CMS acknowledges that training on many of the required topics can be obtained in a nursing home setting while working as a nurse aide under the waiver and through onsite experience and observation.  </div><div> </div><div>AHCA/NCAL strongly encourages states, providers and temporary nurse aides to explore ways to complete the nurse aide training and certification requirements as soon as possible to retain the thousands of individuals who have provided vital care and support to residents throughout the pandemic. The process of transitioning from a temporary nurse aide to a CNA takes time and these pathways vary depending on the state. We encourage you to contact your state licensing agency, state affiliate or AHCA/NCAL at <a href="mailto:educate@ahca.org" target="_blank">educate@ahca.org</a> with any questions. States must ensure that all of the required areas of training per 42 CFR §483.152(b) are addressed, and any gaps in onsite training that are identified are fulfilled through supplemental training. Nurse aides must still successfully pass the state’s competency exam per 42 CFR §483.154. </div><div> </div><div>Currently, it is <a href="https://ccf.georgetown.edu/wp-content/uploads/2021/01/Public-Health-Emergency-Message-to-Governors.pdf" target="_blank">expected</a> that HHS will renew its declaration of public health emergency through the end of 2021 and will provide 60 days’ notice prior to ending it. As long as the PHE is in place, CMS may retain its 1135 waivers. However, CMS could decide to phase out other waivers prior to the end of the PHE if it determines they are no longer needed. CMS will continue to monitor the emergency blanket waivers and may provide future updates.  </div><div><br></div><div>You can access <a href="https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf" target="_blank">more information</a> regarding these changes and current waivers that remain in place. For questions, please contact <a href="mailto:covid19@ahca.org" target="_blank">covid19@ahca.org.</a> <br></div>This week CMS issued a memo announcing it is ending four of the 1135 waivers issued in response to the COVID-19 PHE.
PRF Use – A Refresher and Preparing for Reportinghttps://publish.ahcancal.org/News-and-Communications/Blog/Pages/PRF-Use-–-A-Refresher-and-Preparing-for-Reporting.aspxPRF Use – A Refresher and Preparing for Reporting4/8/2021 4:00:00 AM<p></p><div>All recipients of Provider Relief Fund (PRF) payments must comply with the reporting requirements described in the <a href="https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html#terms-and-conditions" target="_blank">Terms and Conditions</a> and specified in directions issued by the U.S. Department of Health and Human Services (HHS) Secretary. Recipients of PRF payments exceeding $10,000 in aggregate must register in the <a href="https://prfreporting.hrsa.gov/s/" target="_blank">Provider Relief Fund Reporting Portal</a>. At present, there is no deadline for completing registration in the portal. Recipients will later receive a notification about when they should complete the second step of submitting reporting requirements information on the use of funds. The Health Resources and Services Administration (HRSA) will send a broadcast email to the email address you provide during the registration process. The registration process will take at least 20 minutes to complete and must be completed in one session. You cannot save a partially complete registration.  Make sure you have all of the information required to register before you begin.  </div><div><br></div><div>It is important to note that, as of now, PRF must be expended no later than June 30, 2021. HHS will provide directions in the future about how to return unused funds. HHS reserves the right to audit PRF recipients now or in the future, and is authorized to collect any PRF amounts that were overpaid or not used in a manner consistent with program requirements or applicable law. All payment recipients must attest to the Terms and Conditions, which require the submission of documentation to substantiate that these funds were used for health care-related expenses or lost revenue attributable to coronavirus. </div><div><br></div><div>More details on the reporting requirements can be found on the <a href="https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/reporting-auditing/index.html" target="_blank">HHS webpage</a>. AHCA/NCAL also has a <a href="https://educate.ahcancal.org/products/prf-reporting-requirements-updated-january-25th" target="_blank">pre-recorded webex</a> available on the January 15, 2021 PRF reporting registration instructions as well as the updated reporting guidance for members. The recording includes detail on registration, important registration FAQs, recommended terms and conditions, compliance controls, and a PRF reporting update overview. Finally, AHCA/NCAL has a dedicated <a href="/Reimbursement/Pages/COVID-19-Funding.aspx" target="_blank">PRF webpage</a> with resources and information you might find of assistance – including an AHCA/NCAL document that offers detail on use of funds for health care related expenses and transfer of funds to higher need buildings. Please send any PRF related questions to <a href="mailto:COVID19@ahca.org" target="_blank">COVID19@ahca.org</a>.<br></div>All recipients of PRF payments must comply with the reporting requirements described in the Terms and Conditions and specified in directions issued by the HHS Secretary.
Nursing Homes Face Imminent Closures Without Financial Support from Congresshttps://publish.ahcancal.org/News-and-Communications/Press-Releases/Pages/Nursing-Homes-Face-Imminent-Closures-Without-Financial-Support-From-Congress.aspxNursing Homes Face Imminent Closures Without Financial Support from Congress4/8/2021 4:00:00 AM<p></p><div>Nursing homes across the country are in economic turmoil. Long-standing financial shortfalls, largely due to Medicaid underfunding, have been magnified by the COVID-19 pandemic. In addition, the pandemic has worsened chronic workforce shortages and has contributed to a drastic decline in patient census. Many nursing homes were already operating at a loss, and without immediate financial assistance, closures are imminent. </div><div><br></div><div>As Modern Healthcare <a href="https://www.modernhealthcare.com/post-acute-care/pandemic-prompts-rethinking-long-term-care-models" target="_blank">reports</a>, “The pandemic has thrown the long-term care industry into a tailspin.” Andy Edeburn, a principal at consulting organization Premier, said, “Not all nursing homes are going to come back,” and added, “I don’t know that the nursing home industry will ever go back to the way it was … It’s an industry in crisis for a number of reasons.” </div><div><br></div><div>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) <a href="https://d3dkdvqff0zqx.cloudfront.net/groups/ahca/attachments/protect%20access%20to%20long%20term%20care_ib.pdf" target="_blank">estimates</a> that within a two-year period (2020-2021), the long term care industry will lose $94 billion due to the increased costs needed to fight the pandemic and declining revenues. For example, in 2020 alone, nursing homes spent roughly $30 billion on personal protective equipment (PPE) and additional staffing. </div><div><br></div><div>Nursing homes experienced fewer short-term stays amid the pandemic, such as patients coming from the hospital for physical therapy and rehabilitation. From 2020 to 2021, nursing home occupancy declined by 16.5 percent to 68.5 percent. </div><div><br></div><div>More than <a href="https://d3dkdvqff0zqx.cloudfront.net/groups/ahca/attachments/protect%20access%20to%20long%20term%20care_ib.pdf" target="_blank">1,600 nursing homes</a> could close this year as a result of mounting financial challenges. Closures have a devastating impact on residents, their families, and staff. When a nursing home closes, vulnerable seniors are uprooted from their communities and forced to find new care options. The average age of a nursing home resident is 85 – most of whom have multiple underlying health conditions. These residents require a high level of specialized care that in-home care is often unable to provide. </div><div><br></div><div>AHCA and LeadingAge have proposed the <a href="https://www.mcknights.com/news/clinical-news/nursing-home-advocates-urge-24-hour-nurses-ppe-mandates-in-sweeping-reform-agenda/" target="_blank">Care For Our Seniors Act</a> – a package of policy reforms that will help address many of the long-standing challenges in America’s nursing homes. However, implementation will not be possible without a significant investment from Congress and state governments – this includes immediate and long-term solutions to address chronic Medicaid underfunding. Sixty percent of nursing home residents rely on Medicaid for their daily care, and without a commitment from lawmakers to increase Medicaid reimbursement rates, most nursing homes will be unable to afford the substantive reforms required to continue improving quality of care. </div><div><br></div><div>Nursing homes care for our nation’s most vulnerable population, and demand for long term care services will only increase in the years to come. Without support from federal and state lawmakers, financial challenges will continue. We must work together to improve nursing home care and ensure all seniors have access to high-quality long term care options. </div><div><br></div><div><strong>ABOUT AHCA/NCAL </strong></div><div>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit <a href="/Pages/default.aspx" target="_blank">www.ahcancal.org</a>.<br></div>Nursing homes across the country are in economic turmoil.
AHCA Statement on Proposed Rule for Skilled Nursing Facilities’ Medicare Rates and Vaccination Reporting Requirementshttps://publish.ahcancal.org/News-and-Communications/Press-Releases/Pages/AHCA-Statement-on-Proposed-Rule-for-Skilled-Nursing-Facilities’-Medicare-Rates-and-Vaccination-Reporting-Requirements.aspxAHCA Statement on Proposed Rule for Skilled Nursing Facilities’ Medicare Rates and Vaccination Reporting Requirements4/8/2021 4:00:00 AM<p></p><div><strong>Washington, D.C.</strong> — Mark Parkinson, President and CEO of the American Health Care Association (AHCA), made the following statement regarding the Skilled Nursing Facility Prospective Payment System (SNF PPS) FY 2022 proposed rule released by the Centers for Medicare and Medicaid Services (CMS) today.  </div><div> </div><div>“CMS proposes to increase Medicare rates to skilled nursing facilities 1.3 percent in the next fiscal year which would result in an increase of approximately $444 million in Medicare Part A payments to SNFs in FY 2022. </div><div><br></div><div>“Nursing homes across the country continue to dedicate extensive resources to protect their residents and staff from COVID-19. This ongoing work makes government support and robust reimbursement rates more important than ever. With the skilled nursing profession grappling with an economic crisis and hundreds of facilities on the brink of closure due to the pandemic, it is critical that Medicare remain a reliable funding source and reflect the increasing costs providers are facing. </div><div> </div><div>“We also recognize the importance of quality measures associated with COVID-19 including a proposed measure of the COVID-19 Vaccination Coverage among health care personnel. We thank Acting Administrator Richter and the Administration for their support through the pandemic.”</div><div><br></div><div><strong>ABOUT AHCA/NCAL </strong></div><div>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represents more than 14,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and development disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit <a href="/Pages/default.aspx" target="_blank">www.ahcancal.org</a>.​<br></div>Mark Parkinson, President and CEO of AHCA, made the following statement regarding the SNF PPS FY 2022 proposed rule released by CMS today.

​Guidance & Resources

 AHCA/NCAL

Guidance
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Pharmacy Partnership for Long Term Care Program
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