State Health and Value Strategies (SHVS), in partnership with Manatt Health, Georgetown’s Center on Health Insurance Reforms (CHIR), State Health Access Data Assistance Center (SHADAC), Bailit Health, and GMMB developed this resource page to serve as an accessible “one-stop” source of COVID-19 information for states. This resource is designed to support states seeking to make coverage and essential services available to all of their residents, especially high risk and vulnerable people, during the COVID-19 pandemic. SHVS will update this page frequently with new resources as they become available.
| If you have materials you are willing to share with other states through this page, or if there are topics of particular concern that you would like addressed, please contact SHVS. |
On Friday, July 10, State Health and Value Strategies hosted a webinar during which experts from Manatt Health presented key findings from a new COVID-19 state resource guide, funded by The SCAN Foundation. People who use long-term services and supports (LTSS), including individuals dually-eligible for Medicare and Medicaid, are particularly vulnerable to contracting COVID-19. COVID-19 has had a devastating impact on people with complex care needs receiving care in nursing homes and other congregate care settings, in particular. In the resource guide, Manatt Health identifies federal and state Medicaid flexibilities available to state officials and other stakeholders and how those flexibilities are being deployed during COVID-19 to help ensure access to LTSS. The webinar provided examples of how states are ensuring continued access to LTSS by expanding the types of settings in which services can be delivered, bolstering pay and other supports for LTSS providers, and addressing barriers to care created by the COVID-19 pandemic.
CMS issued a sixth version of its toolkit on state actions to mitigate COVID-19 prevalence in nursing homes. The actions enumerated in the toolkit are sourced from healthcare providers, state Governors, and other stakeholders and include those related to cleaning/disinfection, reporting/guidance, testing, workforce and staffing, cohorting, establishing infection control “strike teams,” establishing infection control surveys and other state surveys, nursing home communications, procuring and improving utilization of PPE, housing and sheltering, addressing transportation needs, patient transfer, and telehealth (among others). The toolkit also provides contact information for organizations that can assist with challenges encountered by states and their long-term care settings. The reissue highlights additional state actions for each of these topics.
CMS issued a tip sheet to assist Home Health providers in understanding the status of the Home Health Quality Reporting Program (QRP) during the COVID-19 Public Health Emergency (PHE). Also provided is practical guidance to address Home Health quality data submission requirements starting July 1, 2020, now that the temporary Home Health QRP exemptions from the COVID-19 PHE have ended.
DC requested public comment on its proposal to collect additional data for the residential care community (RCC) and adult day services center survey components of the National Post-Acute and Long-Term Care Study (NPALS). Specifically, the proposal calls for adding supplemental questions related to: – COVID-19 case incidence among service uses and staff- Hospitalizations and mortality data- Availability of PPE – Shortages of COVID-19 testing- Use of telemedicine/telehealth- Restrictions on visitation policies – General infection control policies and practicesThe proposal will be published on the Federal Register on July 28 and public comment will be open until August 26.
CMS announced an additional $5 billion in Provider Relief Fund payments for Medicare-certified long term care facilities and state veterans’ homes (“nursing homes”). Nursing homes must participate in CMS’ Nursing Home COVID-19 Training to be qualified to receive this funding. The training will focus on infection control and best practices and will be available online. CMS also announced it will begin requiring that all nursing homes in states with a 5% positivity rate or greater test all nursing home staff each week. The press release further indicated that federal Task Force Strike Teams have been deployed to provide onsite technical assistance and education to nursing homes experiencing increases in COVID-19 cases among residents. The first deployments took place in 18 nursing homes in Illinois, Florida, Louisiana, Ohio, Pennsylvania and Texas between July 18 and July 20. The White House and CMS will begin releasing a list of nursing homes with an increase in cases that will be made available to states each week.
CMS issued a fifth version of its toolkit on state actions to mitigate COVID-19 prevalence in nursing homes. The actions enumerated in the toolkit are sourced from healthcare providers, state Governors, and other stakeholders and include those related to cleaning/disinfection, reporting/guidance, testing, workforce and staffing, cohorting, establishing infection control “strike teams,” establishing infection control surveys and other state surveys, nursing home communications, procuring and improving utilization of PPE, housing and sheltering, addressing transportation needs, patient transfer, and telehealth (among others). The toolkit also provides contact information for organizations that can assist with challenges encountered by states and their long-term care settings. The reissue highlights additional state actions for each of these topics.
HHS announced a one-time, large-scale procurement of rapid point-of-care diagnostic test instruments and tests to be distributed to nursing homes in COVID-19 hotspots to facilitate on-site testing of nursing home residents and staff. HHS conveyed the distribution will begin the week of July 20 and nursing homes can procure additional tests directly from manufacturers after the initial distribution. HHS further indicated that nursing homes must have the capability to test residents and staff on a weekly basis or according to specific guidance by the state and local health departments.
CMS announced its plans to deploy additional Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in the hotspot areas. QIOs are CMS contractors who work with healthcare providers to help them improve the quality of healthcare they provide to Medicare Beneficiaries. CDC also announced it is implementing an enhanced survey process to better coordinate federal, state and local efforts toward addressing quality and safety concerns for these facilities. On June 1, CMS announced it was allocating $80 million in CARES Act funding to support the deployment of QIOs and survey activities for nursing homes.
This document outlines COVID-19 emergency declaration “blanket waivers” for healthcare providers and is regularly updated by CMS. The June 25 update indicates that CMS has terminated the waiver of 42 CFR 483.70(q) to provide relief to long-term care facilities on the requirements for submitting staffing data through the Payroll-Based Journal system. This is the first termination of a COVID-19 related 1135 waiver and in accompanying guidance, CMS justified the termination on the grounds that more than half of facilities continued to report data, and that staffing data is an important component of assessing quality.
CMS issued FAQs regarding nursing home visitation policies. CMS does not recommend reopening facilities to visitors except for compassionate care situations until:- There have been no new, nursing home onset COVID-19 cases in the nursing home for 28 days – The nursing home is not experiencing staff shortages- The nursing home has adequate supplies of personal protective equipment and essential cleaning and disinfection supplies to care for residents- The nursing home has adequate access to testing for COVID-19- Referral hospital(s) have bed capacity on wards and intensive care unitsThe FAQs also clarify the compassionate care situations for which visitations may be permissible prior to these criteria being met. Additionally, CMS indicated that nursing homes may allow outdoor visitation sessions for residents to meet with loved ones and communal recreational activities with residents who have not tested positive for COVID-19.
MITRE, the independent contractor appointed by CMS to lead the Coronavirus Commission for Safety and Quality in Nursing Homes, announced the 25 individuals who will make up the Commission’s membership. The Commission is made up of resident advocates, infectious disease experts, directors and administrators of nursing homes, academicians, state authorities, clinicians, a medical ethicist, and a nursing home resident. The Commission will conduct a comprehensive assessment of the overall response to the COVID-19 pandemic in nursing homes
CMS issued guidance to all Medicare Advantage Organizations, Part D Sponsors, and Medicare-Medicaid Plans regarding COVID-19 coverage policies. The guidance reiterates that MAOs must comply with general coverage guidelines included in fee-for-service Medicare manuals and instructions, including those related to testing for nursing home residents, which are enumerated in the guidance.
CMS posted the second set of COVID-19 nursing home data since its April 19 announcement that nursing homes are required to report COVID-19 cases and deathsto the CDC. The latest report includes data through June 7 with nursing home- and state- level data related to resident cases, suspected cases, and deaths. The Nursing Home Compare resource allows users to review additional data specific to individual nursing homes.
CMS issued guidance acknowledging allegations that some nursing homes are seizing residents’ CARES Act economic impact payments (or “stimulus checks”) and clarifying that this practice is prohibited. States and the federal government could subject nursing homes in violation to enforcement actions, including potential termination from participation in the Medicare and Medicaid programs. CMS encouraged residents or families of residents who were compelled to sign their stimulus check over to the nursing home to file a complaint.
Populations who use long-term services and supports (LTSS) are particularly vulnerable to contracting COVID-19 and experiencing severe cases, due to their age or because they often live with one or more chronic conditions. This new resource guide identifies federal and state Medicaid flexibilities available to state officials and other stakeholders and how those flexibilities are being deployed during COVID-19 to help ensure access to LTSS.
CMS issued new guidance and data regarding nursing homes and COVID-19. In the guidance, CMS instructs states to complete Focused Infection Control surveys in all Medicare and Medicaid certified nursing homes by July 31. States that have not completed 100% of these surveys by July 31 will be required to submit a corrective action plan to CMS outlining their plan to complete the surveys within 30 days. Additionally, CMS released updated data that includes the percentage of nursing homes surveyed in the state, along with data related to the number of COVID-19 nursing home resident and staff cases and deaths in the state.
CMS released an updated toolkit on state actions to mitigate COVID-19 prevalence in nursing homes. The actions enumerated in the toolkit are sourced from healthcare providers, state governors, and other stakeholders and include topics related to cleaning/disinfection, reporting/guidance, testing, workforce and staffing, cohorting, establishing infection control “strike teams” and surveys, nursing home communications, procuring and improving utilization of personal protective equipment (PPE), housing and sheltering, addressing transportation needs, patient transfer, and telehealth (among others).
CMS approved COVID-19 Section 1135 waiver requests for Arizona which includes a new 1135 waiver authority regarding Medicaid home health and medical equipment. Specifically, the state may delay the required “face-to-face encounter” for up to one year from the date of service (normally, the encounter must occur before the initiation of medical equipment, or within 30 days after the start of home health services).
HHS announced nearly $4.9 billion in awards for over 13,000 skilled nursing facilities (SNFs) in a new targeted allocation of the $175 billion Provider Relief Fund, made available through the CARES and PPPHCE Acts. Skilled Nursing Facilities (SNFs) with six or more certified beds are eligible for payments and may use the payments for critical needs such as labor, scaling up testing capacity, acquiring personal protective equipment and a range of other expenses directly linked to the pandemic. Each SNF will receive a fixed distribution of $50,000, plus a distribution of $2,500 per bed. Recipients must attest that they will only use Provider Relief Fund payments for permissible purposes, as set forth in the Terms and Conditions, and agree to comply with future government audit and reporting requirements.
New York’s Department of Health issued a directive determining that COVID-19 testing of nursing home and adult care facility personnel is medically necessary and twice weekly testing is essential. The health directive was accompanied by a concurrent New York Department of Financial Services directive to insurers requiring coverage of twice weekly testing of all nursing home and adult facility personnel without cost sharing.
New York’s Department of Financial Services released a directive to insurers requiring coverage of twice weekly testing of all nursing home and adult facility personnel without cost sharing. The directive applies broadly to insuers, including Medicaid and Marketplace plans. The insurance directive was accompanied by a concurrent New York’s Department of Health directive determining that COVID-19 testing of nursing home and adult care facility personnel is medically necessary and twice weekly testing is essential.
CDC issued a set of health considerations for states, tribes, localities, and territories as they begin phased re-openings of summer camps, schools, youth sports organizations, institutes of higher education, restaurants, and bars. Considerations are framed as strategies to assist leaders with promoting healthy behaviors, environments, and operations as well as mitigation strategies in the event of incident COVID-19 cases.
CMS issued FAQs for state and local officials, providing recommendations for maintaining infection control and prevention of COVID-19 in nursing homes as states begin phased re-openings. The FAQs address reopening, visitation, and testing requirements.
This document outlines COVID-19 emergency declaration “blanket waivers” for healthcare providers and is regularly updated by CMS. The May 11 update includes several new flexibilities, including, for example:• Relaxed requirements for hospitals to offer “swing-bed” services to patients who qualify for SNF-level care, subject to certain restrictions;• Reduced training requirements for paid feeding assistants in LTC facilities; and,• Expanded the list of clinicians who may perform home health initial and comprehensive assessments (prior waiver added OTs, new waiver adds PTs and speech language pathologists).
CMS issued an interim final rule with comment period (IFC) that provides additional flexibilities for Medicare, Medicaid, and Exchange coverage programs as a result of COVID-19 and also implements regulations in response to recently enacted stimulus legislation.
CMS issued a memo regarding new COVID-19 infection control and reporting rules for nursing homes in the recent interim final rule. The memo indicates CMS will be publicly posting facility-level data from the CDC National Healthcare Safety Network.
This updated document outlines COVID-19 emergency declaration 1135 “blanket waivers” for healthcare providers and is regularly updated by CMS. The April 30 updates add new telehealth-related flexibilities, relax physical environment requirements for providers, and make changes to a number of policies related to Community Mental Health Centers and long term care providers.
The Administration for Community Living (ACL) released an FAQ on $85 million distributed to Centers for Independent Living to address needs of individuals with disabilities and allow them to remain safely in their communities. The FAQ covers funding allocation methodologies, allowable uses of funding, and reporting requirements.
CMS provided additional information on the $100 million in CARES Act supplemental funding for survey and certification efforts of nursing homes, noting it intends to make $81 million of the $100 million available to states through September 30, 2023.
Webinar recording and slide deck from webinar hosted on March 18, 2020.
ACL announced that it is awarding $905 million in CARES Act funding for older adults and people with disabilities.
ACL announced $955 million in CARES Act grants for support of older adults and people with disabilities. These grants will fund services such as home-delivered meals, care services in the home, and respite care; the majority of these funds are being awarded to states, territories, and tribes for subsequent allocation to local service providers.
Guidance from CMS increasing nursing home transparency related to COVID-19, including through reporting cases to the CDC, and notifying residents and families of confirmed cases.
ACL recently opened a competitive funding opportunity for states with Aging and Disability Resource Centers (ADRCs) to support immediate response to urgent needs resulting from COVID-19. $50 million available through this opportunitity and applications are due by April 27.
CMS issues guidance for long-term care facilities transferring or discharging residents between facilities for the purpose of cohorting residents based on COVID-19 status (i.e., positive, negative, unknown/under observation).
CMS released guidance for intermediate care facilites for individuals with intellectual disabilities, and for psychiatric residental treatment facilities, to address infection control and prevention practices.
Guidance from New York State Department of Heatlh on the provision of community based long-term services and supports covered by Medicaid.
This expert perspective, written by experts at Manatt Health, discusses strategies state Medicaid and CHIP agencies can pursue as part of their response to COVID-19.
CMS, in consultation with CDC, issues guidance to state and local governments and nursing homes to help mitigate the spread of COVID-19 in nursing homes.
Summary of five key challenges that long term care providers are facing that require rapid responses and real-time decisions in an evolving COVID-19 policy, regulatory and clinical environment.
This page includes federal background information on Section 1135 waivers and a CMS-developed template for states and territories.
CMS released an interim final rule with comment period that proposes several changes to the Medicaid and Medicare programs. For the Medicaid program, the rule amends health home regulations by allowing other licensed practitioners to order home health services, without physician sign-off.
This guidance allows practitioners further flexibility in prescribing and dispensing buprenorphine to new and existing patients with opioid use disorder via telephone without examination in person or via telemedicine.
Compilation of resources for state on Medicare, Medicaid, and CHIP, including transcripts and recordings of all-state calls
Resources on waivers and flexibilities available to states and providers
This page catalogs CMS’s approved COVID-19 State Section 1135 waivers.
Information for PACE Organizations Regarding Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19)
This page includes 1915(c) Waiver Appendix K templates, instructions, and CMS ‘s approved COVID-19 State Appendix K documents.
This page includes guidance and a template for COVID-19 1115 waiver demonstrations.