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Q I P M OA D M I N I S T R AT O RS U P P O R T G R O U P

I N F O R M AT I O N S H A R I N G S E R I E S

A P R I L 2 3 , 2 0 2 0

M E E T I N G 5

GOVERNOR PARSONSANNOUNCES PHASE II

• Governor Parson announced last week that Missouri’s stay-at-home order will end on May 3rd and then Missouri will begin the three-phase process of opening back up.

• As many of you already know, long term care facilities won’t end the restrictions on visitors and social distancing measures involving communal dining and group activities until CMS/DHSS lifts those restrictions.

• So, your normal will consist of continuing to follow the guidelines put in place by the CDC, CMS and DHSS to keep your residents safe.

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MISSOURI INTERIM GUIDANCE FOR LONG TERM CAREFACILITIES WITH CONFIRMED COVID-19 CASES

https://cdn.ymaws.com/www.mohealthcare.com/resource/resmgr/4.17.20_DHSS_COVID-19_LTCF_G.pdf

1) Consider suspending new admissions.

2) Review potential discharges with family or receiving facilities that residents are transferred to or must visit for care.

State and/or Federal discharge notification requirements must be followed if the resident is being discharged from the facility.

3) Facilities may consider readmitting residents with a positive COVID-19 diagnosis based on their ability to care for such patients. Readmission to long term care for eligible patients from hospitals will help ensure availability of beds for COVID-19 patients with acute care needs. A key component in determining care for these residents is based on the need for Transmission-Based Precautions to continue.

According to the CDC guidance on

Discontinuation of Transmission-Based Precautions of Patients with COVID-19 in Healthcare Settings here https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalizedpatients.html

There are two strategies to determine if Transmission-Based Precautions may be discontinued - a test-based strategy and a non-test-based strategy.

M ISSOURI I NTERIM G UIDANCE FOR LONG T ERM C AREFACILITIES WITH C ONFIRMED COVID-19 C ASES

a. If Transmission-Based Precautions are still required, the facility must have the ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients. Preferably, the patient would be placed in a location designated to care for COVID-19 residents. CDS’s infection prevention and control recommendations can be found at

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html and/or

https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html

b. If Transmission-Based Precautions have been discontinued, but the patient has persistent symptoms for COVID-19 (e.g., persistent cough), they should be placed in a single room, be restricted to their room, and wear a facemask during care

activities until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer. All healthcare staff should use of full recommended PPE (gown, gloves, eye protection, and facemask) when providing care.

c. If Transmission-Based Precautions have been discontinued and the patient’s symptoms have resolved, they do not require further restrictions, based upon their history of COVID-19.

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M I S S O U R I I N T E R I M G U I D A N C E F O R L O N G T E R M C A R E FA C I L I T I E SW I T H C O N F I R M E D C O V I D - 1 9 C A S E S

Ensure advance notification of appropriate health care entities, such as hospitals, medical transport, etc. of suspected or confirmed COVID-19 diagnoses within the facility.

5) Immediately notify the Department of Health and Senior Services utilizing the CD-1 form https://health.mo.gov/living/healthcondiseases/communicable/communicabledisease/cdmanual/doc/CD-1.doc

6) Notify the Local Public Health entity and the Section for Long Term Care Regulation to coordinate patient and contact investigations.

Updated 4-17-20

7) Implement line listing of residents with symptoms, and share at least daily with public health contact(s).

8) Assess the ability of your facility to safely collect specimens for COVID-19 testing. Most local public health agencies do not currently provide this service. For more information on specimen collection-related infection control, please consult the Centers for Disease Control and Prevention recommendations, found here:

https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html#collection

9) Request testing from the Missouri State Public Health Laboratory for any residents with symptoms consistent with COVID-19 by calling the Missouri COVID-19 Information Hotline at 877-435-8411 and coordinate with the Local Public Health entity to acquire testing kits.

• Alternately, commercial testing may also be utilized if the facility has a contract with a private provider or if it will be more expedient for the facility to do so.

• Testing for asymptomatic individuals is not generally recommended under any circumstance or through any laboratory.

• Negative test results on asymptomatic individuals may not accurately reflect infection status.

$30 BILLION INTO HEALTHCARE SYSTEM (RELIEF FUND)

https://www.hhs.gov/provider-relief/index.html

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R ELIEF F UND

Started passing out on April 10, 2020 – to eligible providers throughout the American healthcare system. There are conditions upon whether you get to keep this money or not.

This is a grant payment and not a loan. You must be very careful and make good decisions or there is a possibility that you will be paying this back.

This will show up in your account as an Optum Bank deposit with “HHSPayment” as the description. It is affiliated with United Health Group. If you routinely receive a paper check for reimbursement, you may be waiting on a paper check.

•Within 30 days of receiving your funds, you are required to sign an attestation confirming receipt of and agreeing to the terms and conditions.

•https://www.hhs.gov/sites/default/files/relief-fund-payment-terms-and-conditions.pdf

RELIEF FUND

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RELIEF FUND

It is based on the fee-for-service reimbursements that you received from Medicare in 2019. But it is not a Medicare payment and it should not be added into your accounts as if it is.

If you are a corporate home, it is possible that it will be handled by your central office. They will use your Taxpayer Identification Number (TIN).

R ELIEF F UND

• It is important for you to put in a separate revenue account and come up with specific general ledger expense account numbers for tracking. Only use this money for COVID-19 expenses because if it is not used on COVID-19 expense you very well maybe paying it back. It is 100% for sure that you will get audited. Records that pertain to this grant should be retained for three years.

This Photo by Unknown Author is licensed under CC BY

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Do not use these funds to pay back small business loans.

RELIEF FUND

This Photo by Unknown Author is licensed under CC BY-SA

Tracking: Different homes are going to have different expenses. • More people to pass trays because they are eating in their room.

• Have you purchased more overbed tables because residents are not coming to the dining room?

• Maybe additional staff for infection control procedures.

• Loss revenue, has your census dropped last year in 2019 was it running 75% and now this year it is at 60%?

• Do you have extra staff at the door to take temperature and do your wellness assessment?

RELIEF FUNDS

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RELIEF FUND

• One home put Ultraviolet lights in their HVAC as air scrubbers so that expense is a because of COVID.

• All the PPE that has been purchased. • Cleaning supplies• Meals for employees• Overtime that you have paid due to needing extra staff or loss of staff.• Family leave because staff have a sick relative. • Cost of a COVID-19 unit• Thermometer, concentrators, and pulse ox.

ASK FOR HELP

• If you use an outside accounting firm for accounting services or advising, this is the ideal time to ask for their assistance and their fee would be considered a COVID-19 expense.

This Photo by Unknown Author is licensed under CC BY-ND

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The first Quarterly report will be due

MAY 10, 2020

RELIEF FUND

RELIEF FUND

• Acceptance must occur within 30 days of receipt of payment. Not returning the payment within 30 days of receipt will be viewed as acceptance of the Terms and Conditions, the provider must do the following: contact HHS within 30 days of receipt of payment and then remit the full payment to HHS as instructed. The CARES Act Provider Relief Fund Payment Attestation Portal exit disclaimer icon will guide providers through the attestation process to accept or reject the funds.

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NEW CMS REQUIREMENT

FOR REPORTING COVID-19+

CASES

•CD-1 Form

https://health.mo.gov/living/healthcondiseases/communicable/communicabledisease/cdmanual/pdf/CD-1.pdf

NEW CMS REQUIREMENTS

FOR REPORTING COVID-19+

CASES

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WAIVERS

You will need to notifying all families or responsible parties if you have a case of COVID in your building within 12 hours.

There are systems or program that works with email and or Text out there. The schools

have school reach and maybe nursing homes need something

like that.

• Training and Certification of Nurse Aides:

– CMS is waiving the requirements at 42 CFR 483.35(d) (with the exception of 42 CFR 483.35(d)(1)(i)), which require that a SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements under § 483.35(d). CMS is waiving these requirements to assist in potential staffing shortages seen with the COVID-19 pandemic. To ensure the health and safety of nursing home residents, CMS is not waiving 42 CFR §483.35(d)(1)(i), which requires facilities to not use any individual working as a nurse aide for more than four months, on a full-time basis, unless that individual is competent to provide nursing and nursing related services. We further note that we are not waiving § 483.35(c), which requires facilities to ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care.

COVID-19 EMERGENCY DECL ARATION BL ANKETWAIVERS FOR HEALTH CARE PROVIDERS

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WAIVERS

• https://cdn.ymaws.com/www.mohealthcare.com/resource/resmgr/covid-19/4-17-20_SNF-ICF_Waivers_and_.pdf

• 19 CSR 30-85.042(35)(B) shall be waived to allow a registered nurse to be on duty eight consecutive hours each day rather than specifically on the day shift.

WAIVERS

• Waivers are allowing some of the required inspections and certifications to be delayed. Facilities have until two (2) months after the end of the state of emergency to be current on the required inspections and certifications.

• Fire Extinguishers

• Range Hood

• Fire Alarm Systems

• Sprinkler Systems

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HAND HYGIENE GUIDANCEFROM HQIN

• Health care personnel should use an alcohol-based hand rub or wash with soap and water for the following clinical indications:

• Immediately before touching a patient

• Before performing an aseptic task (e.g., placing an indwelling device) or handling invasive medical devices

• Before moving from work on a soiled body site to a clean body site on the same resident

• After touching a resident or the resident’s immediate environment

• After contact with blood, body fluids, or contaminated surfaces

• Immediately after glove removal

• https://mailchi.mp/3fe6ab62b9fc/simple-strategies-20-seconds-to-stop-infection?e=f34b52dae7

ENVIRONMENTAL MANAGEMENT

1) Ensure that appropriate EPA disinfectants are being used according to instructions for

dilution and contact times.

https://www.epa.gov/sites/production/files/2020-03/documents/sars-cov-2-list_03-03-2020.pdf

2) Implement at least daily cleaning and disinfection of resident rooms.

3) Implement cleaning and disinfection several times a day for high touch surfaces in the facility, such as doorknobs and countertops.

4) Consider dedicated environmental services staff for specific zones in the facility, at a

minimum assigning according to cohort (well, ill) status.

5) Use dedicated medical equipment where possible for each resident and sanitize rental and

shared equipment prior to use.

6) Ensure personnel providing laundry services are using appropriate PPE and performing hand

hygiene after gathering clothing and linens.

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PPE CDC STRATEGIES FOR OPTIMIZING THE SUPPLY

• Strategies for Optimizing the Supply of Eye Protection

• Strategies for Optimizing the Supply of Facemasks

• Strategies for Optimizing the Supply of Isolation Gowns

• Strategies for Optimizing the Supply of N95 Respirators

•Keep Asking and working with vendors

FEDERAL SURVEYS

Federal and state surveyors entering the building should bring their own PPE.

Make sure you screen surveyors.

Take their temperature just like any other visitor.

Surveyors should spend as little time onsite as possible.

They are instructed not to investigate routine issues.

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FEDERAL SURVEY INFECTION CONTROL CEP

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OTHER RESOURCES THAT MAY HELP

• The Interim Final Rule and waivers can be found at:

https://www.cms.gov/about-cms/emergencypreparedness-response-operations/current-emergencies/coronavirus-waivers

• CMS has released guidance to describe standards of practice for infection control and prevention of COVID-19 at:

https://www.cms.gov/files/document/qso-20-14-nh-revised.pdf

• CMS has released guidance to providers related to relaxed reporting requirements for quality

reporting programs at:

https://www.cms.gov/newsroom/press-releases/cms-announces-reliefclinicians-providers-hospitals-and-facilities-participating-quality-reporting

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CLOSING

– Resources are available at:

• QIPMO

• MO DHSS

• MHCA

• CDC

• World Health Organization

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WE ARE HERE TO HELP!!!

• Although we are not allowed to make on site visits at this time, we are available through alternate means. QIPMO has the capability to do virtual one on one meetings, in-servicing, support groups (watch our events page), policy and procedure review, webinars, and much, much more. We know and understand that you are overwhelmed right now; however please reach out to your QIPMO Team Member if we may be of assistance.

• Our next virtual meeting is Thursday, April 30th at 10:30 am. Watch your inbox for an invitation.

• Please complete an evaluation for this program at https://www.surveymonkey.co m/r/CoachingNFVisit (Note: Please select the coach for you region, if you are unsure, you may select all)

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