COVID-19 Updates

 

  COVID-19 Information from CT DPH

       LeadingAge COVID-19 Information Page

 

 

 

COVID-19 Information and Resource

Information from CT DPH

Information from CT DSS

Information from CDC

LeadingAge COVID-19 Information Page

HUD Resources

CDC Long Term Care, Nursing Homes

CDC Criteria for Return to Work for HCP with Confirmed or Suspected COVID-19

CDC Guidance for HCP Exposed to Covid19

CMS Guidance for Nursing Homes March 13

CMS Guidance on Prioritization of Survey Activities (3/23/20)

CDC Guidance for Retirement Communities and Independent Living

DPH, CDC and CMS Revised Guidance on Visitors, Infection Control, Etc. March 13

CMS QSO-20-20-All, Prioritization of Survey Activity March 20

CT DPH COVID-19 Guidance for Long-Term Care Facilities - March 26

CDC: Strategies for Optimizing the Supply of PPE
Posted March 17th on the CDC Website:  Link to Strategies for Optimizing the Supply of PPE

DPH LTC Guidance
On March 26, the Department of Public Health released "COVID-19 Guidance for Long-Term Care Facilities" and provided an overview of the guidance in a telephone presentation this afternoon. The call was recorded: 032720 CT DPH Call with Nursing Homes.

DPH COVID-19 Email Address for Non-Urgent Questions
DPH has an email address for non-urgent questions from health care facilities: [email protected]. This is an email account for leadership in healthcare facilities, EMS, and local health departments. It is meant for organizational inquiries only. More information is on the attached memo. 

Urgent matters should continue to be directed to agency staff you routinely communicate with during business hours for weekend and evenings: 860-509-8000.         

Questions from the general public can be found by calling 211 or texting CTCOVID to 898211.

DPH Recommendations for PPE in Home Health Care
The following is a memo released by DPH providing recommendations on the use of PPE in the home health care setting.

CDC Interim Guidance for Healthcare Workers Return to Work
On March 16, the CDC issued an update to Interim Guidance on criteria for return to work for healthcare personnel with confirmed or suspected COVID-19.  The Interim Guidance can be found here.

Link to all DPH Blast Faxes
All DPH blast faxes are posted on their website at the following link: Link to DPH Blast Faxes

CMS 3 Day Qualifying Stay Waived
CMS is waiving the requirement for a 3-day qualifying hospital stay for coverage of a skilled nursing stay. There had been some confusion at the state level as to whether the state needed to obtain a waiver to take advantage of this, but CMS has clarified that this and several other blanket waiver provisions are automatically in place.

State COVID-19 Testing Protocol
This is the current protocol for testing for COVID-19 in the state. 

State Lab Testing for Health Care Workers
Nursing home patients are given priority status for COVID-19 testing at the State Public Health Laboratory in Rocky Hill. The attached COVID19 Test Requisition Form must accompany the testing specimen which can be delivered to the lab via medical courier. Your commercial laboratory vendor may also be willing to deliver it.

CDC: Strategies for Optimizing the Supply of PPE
Link to Strategies for Optimizing the Supply of PPE

DPH Guidance on PPE Conservation and Testing Strategies
Commissioner of Public Health Coleman-Mitchell sent a memo to all healthcare providers today outlining strategies for the conservation of Personal Protective Equipment (PPE), as well as guidance on COVID-19 testing strategies. To read the entire memo, click here.

CDC Guidance on PPE Burn Rate Calculation
The CDC has released a Personal Protective Equipment (PPE) Burn Rate Calculator which is a spreadsheet-based model that provides information for healthcare facilities to plan and optimize the use of PPE. 

Information on DOL Temporary Guidance on N95 Fit Testing
Department of Labor: Temporary Enforcement Guidance - Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak
We have been told by DPH that a "just in time" fit testing standard is in place. We will continue to seek additional guidance and information on this topic.

CMS Issues Key Protective Mask Guidance for Healthcare Workers
On March 10, CMS sent a memorandum to State Survey Agencies. The memo clarifies the application of CMS policies in light of recent Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) guidance expanding the types of facemasks healthcare workers may use in situations involving COVID-19 and other respiratory infections. This is an effort to ensure a maximum supply of facemasks and respirators are available to enable healthcare providers to safely treat patients without exposing themselves or others to COVID-19.

Blast Fax: Recommendations for the Deceased in Nursing Homes
DPH has issued Blast Fax 2020-21 regarding recommendations for the deceased in nursing homes. It contains guidance to prevent the need for the funeral director to enter the hallways of the facility as well as reminding homes to have a physician's order in the clinical record that permits an RN pronouncement. The Funeral Directors Association suggests contacting the funeral director now to discuss your plans ahead of time to avoid any confusion. 
Note: DPH has also issued Blast Fax 2020-15A regarding How to Certify Confirmed and Suspected COVID-19 Deaths

DPH to Allow Out-Of-State Providers to Provide Services in Connecticut
DPH Commissioner Coleman-Mitchell issued an order earlier today allowing the temporary suspension for a period of sixty days of the requirement of the licensure, certification or registration of certain out-of-state healthcare providers.  The order can be found here.

New CMS Guidance Addresses Nursing Home Access for Hospice Health Care Staff
The guidance CMS released today addresses the question of allowing access to the nursing home for healthcare staff, such as hospice staff. The guidance states that, "CMS is aware that some providers (nursing homes, assisted living facilities, etc.) have significantly restricted entry for staff from other Medicare/Medicaid certified providers who are providing direct care to patients. In general, if the staff is appropriately wearing PPE, and do not meet criteria for restricted access, they should be allowed to enter and provide services to the patient (interdisciplinary hospice care, dialysis, organ procurement, home health, etc.)."

CMS Guidance to Home Health and Dialysis Providers
On March 10, the Centers for Medicare & Medicaid Services (CMS) released guidance to home health agencies and dialysis facilities. The memoranda were developed from frequently asked questions the agency has received about interacting with patients amid COVID-19. The guidance offers clear, actionable information to healthcare workers on the screening, treatment and transfer procedures to follow when interacting with patients.
To view, CMS's guidance for home health providers, visit: Link
To view, CMS's guidance for dialysis facilities providers, visit: Link

CMS Guidance for Hospice
On March 9, CMS issued guidance on the screening, treatment and transfer procedures healthcare workers must follow when interacting with patients to prevent the spread of COVID-19 in a hospice setting. CMS also issued additional guidance specific to nursing homes to help control and prevent the spread of the virus.
To view CMS's guidance for hospice, visit: https://www.cms.gov/newsroom/press-releases/cms-issues-clear-actionable-guidance-providers-about-covid-19-virus 

Adult Day Services Rate for Modified Services
Effective March 23, the state has requested that providers of Adult Day Health Services be permitted to provide and bill for Adult Day  Services for participants who are not able to attend the center in person. In order to bill as a remote service, the provider must contact the client and or a family member and assess the client utilizing a template provided by CAADS. In addition, they must provide a minimum of two meals that would be delivered to the participant. More information can be found on this DSS bulletin or by contacting CAADS at [email protected] 

CMS COVID-19 Elective Surgeries and Non-Essential Procedures Recommendations
The Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak. You can find a copy of the press release here. You can find a copy of the guidance here.

State Requests Letter Be Sent to Nursing Home Residents and Families
On March 30th, the State asked nursing homes to distribute a letter drafted by the state and addressed to residents, family members and responsible parties that provides notice to them that in light of the pandemic, there may at some time be a need to transfer residents to other facilities. It is very vague and does not provide much detail. We were not made aware of this letter until shortly before it was sent and we have voiced our concern that nursing homes are being asked to send a letter that will raise questions that they are not prepared to answer. We are hoping to have more guidance for you. We know that it will be difficult to send this letter blindly to your residents and families and we suggest that you may want to send a personal message along with the state's letter.

LTC Ombudsman Contact Information for Involuntary Transfer/Discharge Notices
As the state offices begin to move toward a more remote workforce, the LTC Ombudsman wants to inform you that while their phone lines will remain open, they are asking that information regarding involuntary/discharge notices be sent by email rather than by fax. The email address is [email protected]

DPH Clarification of Airplane Travel Screening Requirement for Nursing Home Visitors
In the DPH Commissioner's March 13 order, she states that risk screening to be performed for nursing home entry, "shall include, but not be limited to, recent travel history, contact with a person presumed or confirmed positive for COVID-19, fever of 100 degrees or greater, sneezing, cough, sore throat, shortness of breath and recent travel by airplane." We sought clarification from DPH and were told that this is to include all airplane travel, including domestic travel.

DPH Blast Fax - EMTs Are to be Allowed into the Nursing Home
DPH sent out the following blast fax today regarding the need to allow EMTs into the building.

List of Members’ Meal Delivery Current Practices in Assisted Living
Thattached document lists the responses we received from our assisted living and life plan communities in response to the question posed by a fellow member on how people were delivering meals after closing congregate dining. Thank you everyone!

CMS Expansion of Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak
On March 17, CMS announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of health care services from their doctors without having to travel to a health care facility. Beginning on March 6, 2020, Medicare-administered by CMS-will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.
For More Information:
Fact Sheet
Frequently Asked Questions

Telemedicine: CT Medicaid
DSS has circulated two provider bulletins on telemedicine:

PB2020-09 NEW permanent coverage of telemedicine: DSS has developed and will be immediately implementing Medicaid coverage (March 13, 2020) of real-time video conferencing between HUSKY Health members and their health care providers for specific medical and behavioral health services. This reflects new standards for coverage in Medicaid.  

PB2020-10 COVID-19 related expansion of telemedicine: In response to current circumstances related to Covid-19, DSS is also immediately broadening the above coverage to include all evaluation and management services for medical and behavioral health. This will be effective for the duration of the public health emergency.

CT Medicaid Updated COVID-19 Information and FAQs
View Message

CT Child Day Care Resources Update (3/20/20)
The state's Office of Early Childhood (OEC) has issued a new memo updating their policy on temporary child day care established on the grounds of a hospital or nursing home. The new policy extends the licensure waiver to these sites. However, nursing homes should not proceed with any child day care plans within the nursing home building without receiving approval from DPH. The OEC dedicated phone line for health care workers remains in operation and the attached poster can be displayed for your employees.

Department of Labor FAQs - COVID-19
The Connecticut Department of Labor has released frequently asked questions about coronavirus for workers and employees. Learn more here

CBIA Employers Guide - COVID-19
The following is a link to the Connecticut Business and Industry Association's publication: Coronavirus: An Employer's Guide. We will be holding a member call soon on this topic.

Families First Corona Relief Act Q&A Guidance 
March 31 Recording of Member Call 
Dial-in Number: 1-888-203-1112 
Replay Passcode: 518009515 
Wiggin and Dana Advisory

HUD Update
On March 14, HUD published a joint letter from the offices of Public Housing and Multifamily Housing. The letter addresses concerns housing providers and residents may have related to COVID-19 and discusses actions the agency is taking to provide information to stakeholders. The letter contains the following:
Reiterates that REAC inspections have been postponed until further notice due to the virus, and explains how they will handle a health or safety situation where an in-unit inspection may still be required, with more information available in the just released PIH FAQ document, which complements MFH's Q&A document;
Discusses HUD's plan to avoid lapses in housing assistance payments, operations funding, and other HUD actions even in the event of a prolonged agency telework situation; Establishes an email address for multifamily owners and PHAs for submitting questions related to COVID-19.

Housing and COVID-19
Many housing members have asked for updated guidance on whether they can restrict visitors in their communities.  The attached document contains responses to some questions that have been raised.

Employee Cafeteria Guidance and the CT Social Distancing Rules
March 18, This guidance is from DECD Commissioner Lehman on in-house cafeterias in light of the social distancing rules:
"The Governor's Executive Order restricting restaurants and other eating establishments to take out or delivery service does not require onsite workplace cafeterias to close or stop serving food. Employees in general are encouraged to bring their own meals to work if possible rather than using such facilities. To the extent feasible, employers are encouraged to permit or require employees who order food at workplace cafeterias to eat those meals in private work spaces. If employers permit employees to eat food within workplace cafeterias, they should implement appropriate social distancing measures and make every effort to minimize the number of people congregating within a confined space or area."

Governor Issues Order to "Stay Safe, Stay Home"
Governor Lamont has issued an order to Stay Safe, Stay Home effective at 8 p.m. on Monday, March 23, 2020. In the Executive Order, the Governor is encouraging all businesses to employ, to the maximum extent possible, any telecommuting or work-from-home procedures that they can safely implement. This order excludes any essential business or entity providing essential services or functions, such as healthcare, elder care, food service, providers of basic necessities to economically disadvantaged populations and similar critical services. The Governor's press release is printed at the end of this update and you can link to the Executive Order 7H here.

Governor's Executive Order 7F Items of Interest for Aging Services – Telehealth and Critical Legal Functions for Nursing Home Residents
Executive Order No. 7F allows Medicaid  to cover audio-only telehealth services.  It also provides flexibility for critical legal functions that must be carried out in facilities that have limited visitor access due to public health concerns.  The Executive Order permits the nursing home administrator or the administrator's designee to accept personal service on behalf of residents in connection with probate matters involving psychiatric commitment, conservatorships and guardianships and civil court actions.  The administrator is responsible for ensuring that the resident receives the papers that have been served.  The order also allows for hearings, meetings and other proceedings regarding in these matters to be conducted through alternative means such as video conferencing without requiring in-person proceedings with visitor entry into the facility. LeadingAge Connecticut's legal counsel was consulted about the order prior to its implementation and if you have any questions regarding it, please contact me at [email protected].

FAQs on State Actions
Governor Lamont posted a COVID-19 FAQ titled "Frequently Asked Questions on the State of Connecticut's actions related to COVID-19."

DPH March 30 Guidance on Return to Work
Link

Update: 19a-550(c) and Public Health Emergency
DPH has confirmed that because the Governor has declared a Public Health Emergency, a nursing home can utilize the authority of state statute 19a-550(c) to thoughtfully plan to and/or transfer residents to create the physical space and layouts needed to try to protect the health and safety of the residents.

Nebulizer Treatment Protocols
Thattached guidance regarding nebulizer treatments in long term care facilities for patients with diagnosed or suspected COVID-19 was provided by DPH today.

Fire Safety Code Questions
DPH has provided the following information regarding life safety code issues in response to our inquiry. First, fire drills shall continue. Second, inspections and testing for fire alarm, sprinkler, generators, etc. that are interior where vendors will need to travel through the facility for inspection are waived unless it is an emergency repair. Maintenance staff shall continue to do their weekly checks as usual. Any exterior work needed by vendors is permitted. This guidance also applies to Assisted Living MRCs.

Practical Ideas from Members
Look for Member Ideas & Inspiration at this link to the LeadingAge website.
LeadingAge members face new challenges every day as a result of coronavirus. LeadingAge is gathering examples of the innovative solutions you're deploying to better serve older people and support their staff. Read about how organizations around the country are addressing a range of issues, including:
Communicating with Residents: How  are members helping residents/clients connect with families and friends?
Workforce Challenges: How  are members working to make employees' jobs-and personal challenges-easier? 
Managing Meals: How  are members adapting to social distancing with meal delivery?

Update on Veyo on Covid-19 Policies
Veyo, the state's NEMT broker, has provided the attached update on their policies regarding COVID-19. March 30

National CNA Association Releases CNA Education on COVID-19
The National Association of Health Care Assistants (NAHCA) has created and released the first in a series of courses aimed specifically at providing CNAs education on COVID-19. This content is aimed at helping those who work in senior care to protect themselves and those they serve. NAHCA's goal is to support CNAs and all healthcare professionals to provide compassionate and quality care in these difficult times.
The courses are located on NAHCA's website. They are provided free of charge and can be accessed by anyone.

Published Information on Washington's Kirkland Nursing Home Case
COVID-19 in a Long-Term Care Facility - King County, Washington, February 27-March 9, 2020 Early Release / March 18, 2020 / 69 - CDC Website Link to CDC

Accelerated Medicare Payments
Medicare will start accepting and processing the Accelerated/Advance Payment Requests immediately. CMS anticipates that the payments will be issued within seven days of the provider's request. An informational fact sheet on the accelerated/advance payment process and how to submit a request can be found here.

NGS Accelerated/Advance Payment Hotline
National Government Services (NGS) is expanding services to support the provider community and has established a Hotline to help with accelerated/advance payment requests related to COVID-19: 888-802-3898.

Medicare Cost Reports
CMS will delay the filing deadline of FYE 10/31/2019 cost reports and FYE 11/30/2019 cost reports until June 30, 2020. CMS will also delay the filing deadline of the FYE 12/31/2019 cost reports until July 31, 2020.

Medicare Appeals
-CMS is allowing Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) in the FFS program and MA and Part D plans, as well as the Part C and Part D Independent Review Entities (IREs) to allow extensions to file an appeal and to waive certain requirements for timeliness for requests for additional information to adjudicate appeals.
-CMS is allowing MACs, QICs, MA and Part D plans, as well as the Part C and Part D IREs to process an appeal even with incomplete Appointment of Representation forms. However, any communications will only be sent to the beneficiary.
-CMS is allowing MACs, QICs, MA and Part D plans, as well as the Part C and Part D IREs to process requests for appeal that don't meet the required elements using information that is available.
-CMS is allowing MACs, QICs, MA and Part D plans, as well as the Part C and Part D IREs to utilize all flexibility available in the appeal process as if good cause requirements are satisfied.

 

Links to Update

LeadingAge CT Update March 13

LeadingAge CT Update 2 March 13

LeadingAge CT Update March 14

LeadingAge CT Update 2 March 14

LeadingAge CT Update March 15

LeadingAge CT Capitol Line March 16

LeadingAge CT Update March 17

LeadingAge CT Update March 1 

LeadingAge CT Update March 19  

LeadingAge CT Update March 20

LeadingAge CT Update March 21

LeadingAge CT Update March 22

LeadingAge CT Capitol Line March 23

LeadingAge CT Update March 24

LeadingAge CT Update March 25

LeadingAge CT Update March 26

LeadingAge CT Update March 27

LeadingAge CT Update March 28

LeadingAge CT Update March 29

LeadingAge CT Capitol Line March 30

LeadingAge CT Update March 31