January 6, 2021
Agenda
2021 Scheduling
Advocacy Update
Member Experience - Vaccinations
Michigan Situation Update
Vaccination Update
Monoclonal Antibodies
Other Resources and Guidance
Advocacy
Safe and Calm Webinar Schedule January 2021
Starting the first week in January, the Safe and Calm Webinar will be held once weekly on Wednesdays at 10:00 a.m.
The Safe and Calm email address ([email protected]) can be used for any additional issues or questions.
We will continue to disseminate information via the appropriate listserv (SNF, Assisted Living, and/or Housing) between webinars and when appropriate. And we will continue to use COVID Member Updates for other messages
mailto:[email protected]
Advocacy
Michigan does not currently have a legislature until next week.
The new legislature begin next week - The first legislative session will be on January 13th
The Governor’s office has been working on reviewing bills from the last legislative session
All bills that are not signed will need to go through the process again
Currently there is no legislature to adjust the legislation
Governor Whitmer has been vetoing and pocket vetoing a lot of bills
Currently in Lansing….
Advocacy
On December 30th, the Governor signed the new budget
While there was a number of line item vetoes, the
healthcare dollars remained largely untouched.
$103.85 million for vaccination, testing and COVID-19
response efforts
$100.0 million to extend the $2.00 per hour direct care
worker wage increase for an additional 2 months.
$2.0 million to extend the $200 per day enhanced payment
for CRCs for an additional 2 months
Plante & Moran will be doing a review of the state and National budgets and their impact on long term care during tomorrow’s Finance and Strategy Series session.
Supplemental Budget
Senate Bill 1185– Health Care Facility Legal immunity
This bill would have extended the period of legal immunity for healthcare facilities for their response to the COVID-19 pandemic and added CRCs to the definition of a health care facility
Passed along party lines
Trial Attorney Groups have fought very hard to get this legislation vetoed
House Bill 4910/4911 – Misrepresentation of Emotional Support Animals Act
Creates more flexibilities for housing providers who are seeking more information regarding a support animal
Passed with bipartisan support
Advocacy
Directly Vetoed
Bills
http://www.legislature.mi.gov/documents/2019-2020/billenrolled/House/pdf/2019-HNB-4910.pdf
Senate Bill 77 - Electronic Monitoring in SNFs
Passed with bipartisan support
Trial attorney groups are very close with the Governor and some of the legal immunity clauses in this bill are likely the reason this bill was pocket vetoed
House Bill 4098 – Allows for the use of Medication Aides in SNFs
Passed along party lines
This bill has been in the works for years and has struggled to get across the finish line
Traditionally labor groups have opposed the bill
House Bill 4042 – Would add Michigan to the national nurse licensure compact
Passed with bipartisan support
Traditionally labor groups have opposed the bill Advocacy
Pocket Vetoes
http://www.legislature.mi.gov/documents/2019-2020/billanalysis/House/pdf/2019-HLA-4098-43BE623C.pdfhttp://www.legislature.mi.gov/documents/2019-2020/billanalysis/House/pdf/2019-HLA-4042-8E7577C8.pdf
Senate Bill 1021 - Creates license reciprocity for
individuals educated in Canadian
Passed by the full chamber
House Bill 4491 – Would change the licensure
requirements relating too “good moral character”
Only felonies can be reviewed upon licensure application
with some expectations
Passed with bipartisan support
Advocacy
Signed Bills
http://www.legislature.mi.gov/documents/2019-2020/billenrolled/House/pdf/2019-HNB-4491.pdf
1/31/2020Estimated end date for the distribution of the 3rd round of PRF funds
2/1/2021Deadline for SNFs to submit expenditure documentation of the Nursing Facility Infection Prevention grant funds to MDHHS
2/28/20End of the third reimbursement period for Direct Care Worker Wage Pass-through payments
2/28/2020 End of the $200 Enhanced CRC payments
Advocacy Questions?
Advocacy
Member Experiences
Vaccines
Libby DelaneyBellbrook
Barb GilesJewish Senior Life
Paul BarberHeritage Community
Kristen Packard Grand Traverse Pavilions
Michigan
Situation
Update
0
1000
2000
3000
4000
5000
6000
7000
8000
Michigan 7-Day Rolling Average of Daily New Cases – 1/5/2021
0
20
40
60
80
100
120
140
160
Michigan 7-Day Rolling Average of New Daily Deaths – 1/5/2021
CMS Positivity
Rates Michigan
12/30/2020
0
10
20
30
40
50
60
70
12/2/2020 12/9/2020 12/16/2020 12/23/2020 12/30/2020
CMS County Positivity Rates, week ending….
Red Yellow Green
All but 7 Michigan Counties
continue to be Risk Level E 1/4
0
200
400
600
800
1000
1200
1400
11/2/2020 11/9/2020 11/16/2020 11/23/2020 12/1/2020 12/8/2020 12/14/2020 12/22/2020 12/28/2020 1/4/2021
Series 1 322 532 719 792 1126 1150 1091 753 514 415
Michigan SNF Weekly Case Reporting 11/2/2020-1/4/2021
0
20
40
60
80
100
120
140
160
180
200
11/2/2020 11/9/2020 11/16/2020 11/23/2020 12/1/2020 12/8/2020 12/14/2020 12/22/2020 12/28/2020 1/4/2021
Series 1 0 54 185 182 168 162 134 151 172 157
Michigan HFA Weekly Case Reporting 11/2/2020-1/4/2021
0
20
40
60
80
100
120
140
160
180
200
11/2/2020 11/9/2020 11/16/2020 11/23/2020 12/1/2020 12/8/2020 12/14/2020 12/22/2020 12/28/2020 1/4/2021
Series 1 0 13 87 64 122 190 174 182 141 146
Michigan AFC Weekly Case Reporting 11/2/2020-1/4/2021
1/4/2021 SNF HFA AFC Total Total LTCFCases
Total LTCFDeaths
New Resident Cases 415 157 146
New Resident Deaths 191 39 13 243
Cumulative Resident Cases
16499 2862 2047 21408
Cumulative Resident Deaths
3683 826 390 4650
Staff New Cases 455 171 109 735
Staff New Deaths 2 0 1 3
Cumulative Staff Cases 12702 2750 1754 17206
Cumulative Staff Deaths
34 4 26 64
38,614 4,711
Increased from last week
Resources and Guidance
Updated MDHHS Vaccination Strategy
Vaccinations-Includes priorities to categorize risk for essential workers
Coronavirus - COVID-19 Vaccine (michigan.gov)Critical Infrastructure Protection • Complex and will take time to determine • Essential workers not covered in earlier phases – Phase 1C• Goals: Decrease death and serious disease as much as
possible; preserve function of society; Reduce the extra burden on people already facing disparities
• Priorities• 1A Critical health care; Long term care staff and
residents; necessary healthcare• 1B Frontline essential workers who keep critical
infrastructure, persons over 75• 1C Persons at risk of serious illness, other essential
workers• 2 – all others 16 years and older
https://www.michigan.gov/coronavirus/0,9753,7-406-98178_103214---,00.html
Michigan Vaccine UpdateNew CDC vaccinations count at website from CDC that tracks COVID vaccinationsby state and county, as well as by selected populations such as long-term care residents.
Additional vaccines in testingEstimate that 100 million doses will be available by the end of February
Current bottlenecks seems to exist in distribution rather than manufacturing
April/May is the estimate start of healthy adult vaccinationsAnother 2-3 weeks will tell us about the holiday surgeWe will need 80-90% vaccination to achieve herd immunity
https://nam04.safelinks.protection.outlook.com/?url=https://covid.cdc.gov/covid-data-tracker/#vaccinations&data=04|01|[email protected]|b4f414e142a343cccdbc08d8b245be71|2226fa7d26a64fc0a3c8a38dc7a23f80|0|0|637455359926641571|Unknown|TWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D|1000&sdata=xjcyChgsDabbwumMgKgUIpfW3zhnpB5t0y3Z1qqBaRs%3D&reserved=0
CDC COCA (Clinician Outreach and Communication Activity)Webinar 12/30 on vaccineshttps://www.leadingagemi.org/resource/resmgr/covid-19/documents/dec-30-coca-call.pdf
CDC Recommendations for allergic reactionshttps://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/allergic-reaction.html
MDHHS clinic date confirmations at https://info.omnicare.com/covid-19-clinic-confirmation.html
LeadingAge Vaccine FAQsFAQs and Resources on COVID-19 Vaccines - Dec 15.pdf (leadingage.org)
HUD Section 202 – Pharmacy Program Toolkit – LeadingAgeVaccine Toolkit Affordable Housing_0.pdf (leadingage.org)
CDC Updates on Vaccines• https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html• https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Pfizer-
BioNTech.html• https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html
https://www.leadingagemi.org/resource/resmgr/covid-19/documents/dec-30-coca-call.pdfhttps://nam04.safelinks.protection.outlook.com/?url=https://info.omnicare.com/covid-19-clinic-confirmation.html&data=04|01|[email protected]|79eb69e99ec1484395b808d8b0d85af6|2226fa7d26a64fc0a3c8a38dc7a23f80|0|0|637453790570519240|Unknown|TWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D|1000&sdata=0MbfbdWl3TGgpy%2BCp3aFjF7VE7PbJSNcTYTdkG0RvyU%3D&reserved=0https://www.leadingage.org/sites/default/files/FAQs%20and%20Resources%20on%20COVID-19%20Vaccines%20-%20Dec%2015.pdf?_ga=2.116528134.1813536801.1609888835-1533915436.1525359211https://leadingage.org/sites/default/files/Vaccine%20Toolkit%20Affordable%20Housing_0.pdfhttps://nam04.safelinks.protection.outlook.com/?url=https://info.omnicare.com/covid-19-clinic-confirmation.html&data=04|01|[email protected]|79eb69e99ec1484395b808d8b0d85af6|2226fa7d26a64fc0a3c8a38dc7a23f80|0|0|637453790570519240|Unknown|TWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D|1000&sdata=0MbfbdWl3TGgpy%2BCp3aFjF7VE7PbJSNcTYTdkG0RvyU%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https://info.omnicare.com/covid-19-clinic-confirmation.html&data=04|01|[email protected]|79eb69e99ec1484395b808d8b0d85af6|2226fa7d26a64fc0a3c8a38dc7a23f80|0|0|637453790570519240|Unknown|TWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D|1000&sdata=0MbfbdWl3TGgpy%2BCp3aFjF7VE7PbJSNcTYTdkG0RvyU%3D&reserved=0https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html
HUD Q&A Update - 1/4/2020
Addresses vaccines in housing, but questions still exist. Temporary use of common or vacant areas for testing or vaccinations is allowable – cannot affect operating costs beyond budgeted
Extended eviction moratorium to January
Management and Occupancy Reviews may continue to be conducted without entering resident units until May 31 …total suspension only where there are no local or state restrictions
Project Capital Needs Assessment delayed until May 31, 2021
https://www.leadingagemi.org/resource/resmgr/covid-19/documents/HUD_Multifamily_Corona_QA_FI.pdf
https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.leadingagemi.org%2Fresource%2Fresmgr%2Fcovid-19%2Fdocuments%2FHUD_Multifamily_Corona_QA_FI.pdf&data=04%7C01%7CDeanna%40leadingagemi.org%7C276dce7557c8478ae2ae08d8b10b8b12%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637454010428840902%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=%2B5UMkahOMgY%2B%2BY0838WSsGB5rkDksE2N1XTwX3vgFLM%3D&reserved=0
Monoclonal Antibodies• FDA EUA for bamlanivimab for persons with mild to moderate
COVID at least 12 years of age• At high risk for progressing to severe COVID 19 and/or
hospitalization
Not authorized for those• Currently hospitalized for COVID• Who require oxygen therapy due to COVID or• Who require an increase in baseline oxygen flow rate due to
COVID for those on chronic oxygen therapy
• Benefits have not been observed in hospitalized patients, and maybe associated with worse outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation.
Monoclonal Antibodies• High Risk means having at least one of the following:
• Body mass index equal to or greater than 35• Chronic kidney disease• Diabetes• Immunosuppressive disease or currently receiving
immunosuppressive treatment• Over age 65• At least 55 with CVD, hypertension, or COPD/resp• Age 12-17 with
• BMI > 85th percentile for age/geneder• Sickle cell disease• Congenital or acquired heart disease• Neurodevelopmental disorders such as cerebral palsy• Medically related technological dependence such as
gastrostomy, tracheostomy• Asthma or other chronic airway disease requiring daily
medication• Provided by IV infusion
FDA Fact Sheet for Healthcare Providershttps://www.fda.gov/media/143603/download
https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fda.gov%2Fmedia%2F143603%2Fdownload&data=04%7C01%7CDeanna%40leadingagemi.org%7Ce86409bb99a04b395fca08d8b0c33fe9%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637453699937141960%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=CbBIxGagU0nFInAc1Jr42Zc0OFyqdFlxEeGnwoSuN6o%3D&reserved=0
Monoclonal Antibodies – Other Resources
FDA Fact Sheet for Patients / Caregivershttps://www.fda.gov/media/143604/download
FDA Fact Sheet for Healthcare Providershttps://www.fda.gov/media/143603/download
NEJM Article on Bamlanivimabhttps://www.nejm.org/doi/full/10.1056/NEJMoa2029849
Info from CMS on Reimbursement for Infusionshttps://www.cms.gov/medicare/covid-19/monoclonal-antibody-covid-19-infusion
Patient Profile Form - To be completed for each patient receiving mAb therapy (also attached printable form that can be used to collect the data to be entered later into the form.https://forms.office.com/Pages/ResponsePage.aspx?id=sgF4Zzdipk67RItjfx6ergRINfmr3E1Njq-ZF3K4vsBUMjRaVE43VjM1MFJRTllCVzBMMk9HWVVBTiQlQCN0PWcu
Patient Follow-up Form - To be completed when patients within 14 days of administration of mAbare hospitalized or die. Also attached is a printable version.https://forms.office.com/Pages/ResponsePage.aspx?id=sgF4Zzdipk67RItjfx6eroELYMLt2W5FvlKQ7QFuQSZUN1lGRzRXWUFTNEsyUUhXS1dCSU5DQThTNi4u
https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fda.gov%2Fmedia%2F143604%2Fdownload&data=04%7C01%7CDeanna%40leadingagemi.org%7Ce86409bb99a04b395fca08d8b0c33fe9%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637453699937131968%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=EtHqsaDNDjXa4FleXFZJvukDyA%2Fe%2BQOZ5Jo8pmaVBw8%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fda.gov%2Fmedia%2F143603%2Fdownload&data=04%7C01%7CDeanna%40leadingagemi.org%7Ce86409bb99a04b395fca08d8b0c33fe9%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637453699937141960%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=CbBIxGagU0nFInAc1Jr42Zc0OFyqdFlxEeGnwoSuN6o%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.nejm.org%2Fdoi%2Ffull%2F10.1056%2FNEJMoa2029849&data=04%7C01%7CDeanna%40leadingagemi.org%7Ce86409bb99a04b395fca08d8b0c33fe9%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637453699937141960%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=PFSMVzmMnqU8CAKV1PrBRM0%2FmIReHb71Bnq6K5PZayM%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.cms.gov%2Fmedicare%2Fcovid-19%2Fmonoclonal-antibody-covid-19-infusion&data=04%7C01%7CDeanna%40leadingagemi.org%7Ce86409bb99a04b395fca08d8b0c33fe9%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637453699937151957%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=z7q4xcDphlmnjbFDjtjHaOSEqDqaILEZliF7WXz%2BIHQ%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fforms.office.com%2FPages%2FResponsePage.aspx%3Fid%3DsgF4Zzdipk67RItjfx6ergRINfmr3E1Njq-ZF3K4vsBUMjRaVE43VjM1MFJRTllCVzBMMk9HWVVBTiQlQCN0PWcu&data=04%7C01%7CDeanna%40leadingagemi.org%7Ce86409bb99a04b395fca08d8b0c33fe9%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637453699937151957%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=x1AlZfF%2FYrC%2BHPGiAt1RIEkXvhf1VfdEeQMKv77%2F4Xs%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fforms.office.com%2FPages%2FResponsePage.aspx%3Fid%3DsgF4Zzdipk67RItjfx6eroELYMLt2W5FvlKQ7QFuQSZUN1lGRzRXWUFTNEsyUUhXS1dCSU5DQThTNi4u&data=04%7C01%7CDeanna%40leadingagemi.org%7Ce86409bb99a04b395fca08d8b0c33fe9%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637453699937161949%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=xcHD4qU5iGjk%2BVdCnWmsUSEONsIHkUR%2BMcxmKwOOaW8%3D&reserved=0
Michigan Project Speed
Medication provided at no cost; distributed through hospitals in MIRapid response – less than 24 hours to SNFs with large outbreaksMDHHS responsible for allocating Resources – MDHHS Mobile Crisis Teams and local paramedicsRequest state support through local public health or regional health care coalitionsMDHHS can provide technical support
SNF mAB Presentation: https://www.leadingagemi.org/resource/resmgr/covid-19/documents/SNF_mAb_Presentation.pdf
Bamlanivimab Order Form: https://www.leadingagemi.org/resource/resmgr/covid-19/documents/Bamlanivimab_Order_Form.V2.1.pdf
mAB Therapy Patient Follow-Up: https://www.leadingagemi.org/resource/resmgr/covid-19/documents/mAb_Therapy_Patient_Follow-u.pdf
mAB Therapy Patient Profile: https://www.leadingagemi.org/resource/resmgr/covid-19/documents/mAb_Therapy_Patient_Profile_.pdf
https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.leadingagemi.org%2Fresource%2Fresmgr%2Fcovid-19%2Fdocuments%2FSNF_mAb_Presentation.pdf&data=04%7C01%7CDeanna%40leadingagemi.org%7Cbcd9e1d6266e46c756b808d8b24d08c5%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637455391236952432%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=lrZLvEtZgs78%2FEWyAKDB8AH9XrvG%2B4pO0JWq490Fa5Q%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.leadingagemi.org%2Fresource%2Fresmgr%2Fcovid-19%2Fdocuments%2FBamlanivimab_Order_Form.V2.1.pdf&data=04%7C01%7CDeanna%40leadingagemi.org%7Cbcd9e1d6266e46c756b808d8b24d08c5%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637455391236962424%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=FatfZqLXb4yNHaxEUd7EhQwaH3etrIlvO8ykVtVbcB8%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.leadingagemi.org%2Fresource%2Fresmgr%2Fcovid-19%2Fdocuments%2FmAb_Therapy_Patient_Follow-u.pdf&data=04%7C01%7CDeanna%40leadingagemi.org%7Cbcd9e1d6266e46c756b808d8b24d08c5%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637455391236962424%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=UyysBVY3k29F7VISihi1vW1byBilEpEox3I0DfFFCNs%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.leadingagemi.org%2Fresource%2Fresmgr%2Fcovid-19%2Fdocuments%2FmAb_Therapy_Patient_Profile_.pdf&data=04%7C01%7CDeanna%40leadingagemi.org%7Cbcd9e1d6266e46c756b808d8b24d08c5%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637455391236972420%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=HOKm4KBf%2BjzWhbchK0FHWh7oSERLvCnLSl8JNKhihbs%3D&reserved=0
Questions?
PPP Second Draw
Second draw loans are available to most organizations that received an initial PPP loan and can demonstrate a reduction in gross receipts of at least 25%.
https://www.leadingagemi.org/resource/resmgr/covid-19/documents/PPP_second_draw.pdf
FMLAMandatory paid sick leave and FMLA leave ended December 31, 2020. However the Consolidated Appropriations Act (HR 133) that the President signed on Dec. 27 does allow employers to provide paid leave voluntarily for COVID-related reasons set out in FFCRA (and be reimbursed through payroll tax reductions). Here are updated FAQs. https://leadingage.org/legislation/paid-sick-leave-and-fmla-leave-no-longer-mandatory
https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.leadingagemi.org%2Fresource%2Fresmgr%2Fcovid-19%2Fdocuments%2FPPP_second_draw.pdf&data=04%7C01%7CDeanna%40leadingagemi.org%7C36834d47416a4f3e3b6308d8b0c00e34%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637453686198034232%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=prsfjgBkj9pNWvlbzAGOfVqcs7sW98VhIgf%2FYV5Iy%2BM%3D&reserved=0https://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fleadingage.org%2Flegislation%2Fpaid-sick-leave-and-fmla-leave-no-longer-mandatory&data=04%7C01%7CDeanna%40leadingagemi.org%7Cb480217cf09a491a0c2508d8b19b0a65%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637454626734796088%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=eJbMWe6av8dSIS87NPEILMEM%2F1r%2Bab75uZL7YETudPc%3D&reserved=0
Updated Provider Relief Q&A from HHSProvider Relief is the Payer of Last Resort.Here’s a PRF Q and A on this topic that was added this week; some states have advised providers to apply for and use PRF before Medicaid reimbursement including Medicaid COVID 19 Supplemental Payments to cover healthcare related expenses or lost revenues – added 12/28/2020CARES Act Provider Relief Fund Frequently Asked Questions (hhs.gov)
This is not permissible…
As it relates to expenses, providers identify their health care-related expenses, and then apply any amounts received through other sources (e.g., direct patient billing, commercial insurance, Medicare/Medicaid/CHIP, reimbursement from the Provider Relief Fund COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured, or funds received from FEMA or SBA/Department of Treasury’s Paycheck Protection Program) that offset the health care-related expenses. Provider Relief Fund payments may be applied to the remaining expenses or cost, after netting the other funds received or obligated to be received which offset those expenses.
https://www.leadingagemi.org/resource/resmgr/covid-19/documents/HUD_Multifamily_Corona_QA_FI.pdf
https://www.hhs.gov/sites/default/files/provider-relief-fund-general-distribution-faqs.pdfhttps://nam04.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.leadingagemi.org%2Fresource%2Fresmgr%2Fcovid-19%2Fdocuments%2FHUD_Multifamily_Corona_QA_FI.pdf&data=04%7C01%7CDeanna%40leadingagemi.org%7C276dce7557c8478ae2ae08d8b10b8b12%7C2226fa7d26a64fc0a3c8a38dc7a23f80%7C0%7C0%7C637454010428840902%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=%2B5UMkahOMgY%2B%2BY0838WSsGB5rkDksE2N1XTwX3vgFLM%3D&reserved=0
CDC
Updates
Considerations for Retirement Communities and Independent Living Facilities – 12/29/2020
o Defines the type of facilities covered under the guidance
o Defines facility behaviors that drive COVID risk for the community
o Summarizes essential elements and resources for the development of an emergency response plan
o Identifies key facility behaviors to mitigate risk
https://www.cdc.gov/coronavirus/2019-ncov/community/retirement/considerations.html
CDC Updates
Summary for Healthcare Facilities – Optimizing N95s---12/29/2020Engineering Controls: place patients with suspected or confirmed SARS infection in an airborne infection isolating room for AGP when possible.Use physical barriers at reception areas and between patientsProperly maintain ventilation systems to provide air movement from clean to contaminated areasAdministrative controls: Use telemedicine where possibleLimit personnel not directly involved in resident careLimit face to face patient encountersLimit visitors to those essential to comfort and well beingImplement source control for everyoneCohort infected personsCohort personnelTrain staff or proper use, fit, donning and doffing of N95sImplement just in time fitting. Plan for larger scale evaluation, training and fit testing when necessaryLimit respirators during training – allow limited re-use of respirators by one individual for training and then fit testingImplement qualitative fit testing to minimize destruction and allow for re-use
https://www.cdc.gov/coronavirus/2019-ncov/hcp/checklist-n95-strategy.html
CDC Updates
Summary for Healthcare Facilities – Optimizing N95s/12/29/2020PPE: Respiratory Protection• Use surgical N95s only for persons who need protection from both
airborne and fluid hazards – if unavailable, use faceshield over standard N95
• Use alternatives to N95s when feasible • NIOSH approved particulate filtering facepieces• https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/d
efault.html• Elastomeric respirators with filters or cartridges• https://www.youtube.com/watch?v=8wd5Bx2fVDI• Powered air purifying respirators• https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-
strategy/powered-air-purifying-respirators-strategy.html• Contingency strategies during expected shortages
• Temporarily suspend annual fit testing per OSHA guidance
https://www.cdc.gov/coronavirus/2019-ncov/hcp/checklist-n95-strategy.html
https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.htmlhttps://www.youtube.com/watch?v=8wd5Bx2fVDIhttps://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/powered-air-purifying-respirators-strategy.html
CDC Updates
Summary for Healthcare Facilities – Optimizing N95s/12/29/2020PPE: Respiratory ProtectionCrisis Strategies• Use respirators beyond the manufacturer shelf life that have been
identified by the CDC as performing adequately• Use respirators approved under standards used in other countries that
are similar to NIOSH approved respirators• Implement limit re-use of N95 to nor more than five donnings per
device by the same individual. • Use additional respirators beyond shelf life that ARE NOT identified by
the CDC as performing adequately for healthcare delivery• Prioritize the use of N95 respirators and masks by activity type,
distance from patient, and use of source control by patient
When there are NO N95s availableConsider excluding staff who are at high risk for illness Use a ventilated headboard to decrease risk of staff exposure to patient generated aerosol
https://www.cdc.gov/coronavirus/2019-ncov/hcp/checklist-n95-strategy.html
Discussions with MIOSHA
N95s required for AGP for those who are COVID positive or have been exposed
N95s required for COVID related care
KN95 can be used if persons are not COVID positive nor have been exposed or if not carrying out AGP. Other COVID protections must be in place.
When N95s are used, fit testing is required but a test check rather than a fit test can be used if kits are not available and documented. The use of a fit check video or other fit check training of staff is required. (https://www.youtube.com/watch?v=CoSb-HJJ5tk .
MIOSHA and
N95s
This is what we
are hearing….it
is not clearly
written in any
guidance.. We
are tracking
this
https://www.youtube.com/watch?v=CoSb-HJJ5tk
COVID Relief FacilitiesMSA 20-76 – exempts CRFs who will be admitting new COVID positive residents from the 85% occupancy limitation ONLY for the designated space for COVID positive residents.
All admissions-approved CRFs will be required to use the Bed Capacity Change form to apply for any increase or decrease in bed capacity and MDHHS will provide a formal determination in response.
Infection Control Survey Triggers -Released 1/4/2020
• 3 or more cases new in a week or 1 new case in a previously COVID free facility along with at least one of the following
• Multiple weeks of new cases
• Low staffing
• Selection as a special focus facility
• Concerns related to conducting outbreak testing
• Allegations or complaints related to abuse or quality of care triaged at level of harm or immediate jeopardy
• Within 3-5 days of identification unless surveyed in past 3 wks
• Enhanced enforcements still in place but not updated
• New FAQs
CMSQSO 20-31-ALL
Surveys will continue during an outbreakCOVID positive residents will be interviewedCMS will not be mandating surveyor testingRelationship to 1135 Blanket Waivers
Final Questions
Thank You MembersFor all that you do…
For all that you give…
For your dedication and patience….
[email protected]@[email protected]
mailto:[email protected]:[email protected]:[email protected]Top Related