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. |
The Center for Medicaid and CHIP Services (CMCS) released a State Medicaid Director Letter to facilitate the continuation of home and community-based services (HCBS) waiver flexibilities requested by states during the COVID-19 Public Health Emergency (PHE). The letter automatically amends the expiration date of approved Appendix K provisions to be the later of November 11, 2023 or the effective date of amendments to underlying 1915(c) waivers to incorporate relevant PHE flexibilities. This ensures states, providers, and enrollees that there will be no disruption to the HCBS delivery system for PHE flexibilities the state requests to incorporate into ongoing HCBS waiver programs.
CMS released an informational bulletin regarding the end of the COVID-19 National Emergency on April 10, 2023, and the expected expiration of the COVID-19 Public Health Emergency (PHE) on May 11, 2023. To learn more about the implications of the end of the COVID-19 National Emergency and COVID-19 PHE for Medicaid and the Children’s Health Insurance Program (CHIP), please see the full bulletin.
Governor Janet Mills announced that her administration has issued $25 million in one-time COVID-19 payments to 211 long-term care organizations to help them recover from the COVID-19 pandemic. Governor Mills proposed the MaineCare (Medicaid) payments in her supplemental budget.
CMS announced that states will have an additional year—through March 31, 2025—to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based (HCBS) services for people with Medicaid who need long-term services and supports.
The Wisconsin Department of Health Services announced the Moving Forward Together Grant Program, a new funding opportunity to support continued efforts to promote health equity in COVID-19 vaccination in Wisconsin. Eligible organizations can apply for awards of up to $400,000 to advance efforts to address barriers to COVID-19 vaccination. Eligible organizations include licensed residential and community-based care facilities, educational institutions, churches or religious groups, local or tribal community-based organizations, and non-traditional providers or locations that serve high-risk populations.
Strengthening and Investing in Home and Community Based Services for Medicaid Beneficiaries: American Rescue Plan Act of 2021 Section 9817 Spending Plans and Narratives
On March 11, 2021, President Biden signed the American Rescue Plan Act into law, enacting a sweeping $1.9 trillion COVID-19 relief package. The legislation includes a number of provisions that will significantly impact state and federal health care policies and programs, including enhanced federal funding for state Medicaid spending on home- and community-based services (HCBS). Beginning April 1, 2021 and through March 31, 2022, states will be eligible to receive a 10 percentage point increase in their federal medical assistance percentage—the share of state Medicaid spending that is paid for by the federal government—for specified HCBS. This brief describes ARPA’s HCBS FMAP increase provision, the requirements for states receiving the enhanced federal funding, and considerations and next steps for state policymakers.
The American Rescue Plan Act includes a number of provisions that will significantly impact state and federal health care policies and programs, including enhanced federal funding for state Medicaid spending on home- and community-based services (HCBS). Beginning April 1, 2021 and through March 31, 2022, states will be eligible to receive a 10 percentage point increase in their federal medical assistance percentage (FMAP)—the share of state Medicaid spending that is paid for by the federal government—for specified HCBS. This brief describes ARPA’s HCBS FMAP increase provision, the requirements for states receiving the enhanced federal funding, and considerations and next steps for state policymakers.
In an updated and expanded resource guide prepared on behalf of The SCAN Foundation, 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 resource guide also highlights state policy goals in implementing regulatory flexibilities available during the COVID-19 public health emergency, as well as specific examples of how states are ensuring continued access to LTSS by expanding remote service delivery options, expanding and stabilizing providers and the LTSS workforce, maintaining continuity of care for LTSS recipients through modified assessment policies and processes, and extending home care to new populations.
HHS announced its plans for continued support of SARS-CoV-2 testing efforts by states and territories in the first quarter of 2021, including:
– Continued weekly shipments of SARS-CoV-2 sample collection supplies to states and territories through at least March 2021
– Collaboration with the General Services Administration (GSA) to provide a streamlined process for states, territories, and other government agencies to purchase point-of-care diagnostic tests. Through a contract between the federal government and Abbott, states, territories, and tribes will be able to purchase tests at a fixed price through an existing Federal Supply Schedule program. The contract eliminates the need for states and territories to spend resources negotiating and establishing individual purchasing contracts with manufacturers. The maximum number of tests that states and territories will be able to purchase each month will be predetermined to help ensure adequate supplies for all on an ongoing basis. The program is expected to launch in mid-January.
– Allocating an additional 30 million Abbott BinaxNOW tests for nursing homes, assisted living facilities, and home health care, hospice organizations, HBCUs, tribes, and other vulnerable groups likely through March 2021.
HHS Announces New Half Billion Incentive Payment Distribution to Nursing Homes.
CMS issued an alert to nursing home staff, residents and visitors urging compliance with guidelines for visitation and adherence to infection prevention protocols. The guidance recommends that facilities encourage virtual parties or visits that limit the risk of transmission, but provides additional recommendations for precautions that residents should take if they decide to take holiday leave to see family. CMS encouraged nursing homes to increase diligence on monitoring for signs and symptoms; testing; transmission-based precautions for any residents that were away from nursing homes during the holiday.
CMS issued a thirteenth 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 that it is distributing the first performance-based Provider Relief Fund payments to nursing homes. Earlier this summer, HHS announced that it would issue approximately $2 billion in payments to nursing homes, based on their performance against measures of COVID-19 infection and mortality; this first payment–totaling $333 million–is the first of five performance-based payments (payments will be made in October through January based on the prior month’s performance; the February payment will be based on aggregate performance across performance periods). Over 77% of nursing homes (or 10,631 nursing homes) met the gating infection control criteria and, of those 10,631, 76% qualified for payments.
HHS published state-by-state data about the allocation; however, a share of payments appear to be missing from the state-by-state data (HHS indicates that $333 million in payments are being distributed, but shows a total of $250.7 million in the state-by-state data). HHS indicates that it will update this data to capture all recipients as disbursements continue.
CMS launched a new online platform, the Nursing Home Resource Center, to serve as a centralized hub bringing together the latest information, guidance and data on nursing homes for facilities, providers, residents, and residents’ families. CMS plans to maintain this resource, during and after the public health emergency.
OSHA issued respiratory protection guidance focused on protecting workers in nursing homes, assisted living and other long-term care facilities (LTCFs) from occupational exposure to SARS-CoV-2. The guidance advises the use of cloth face coverings, facemasks, or surgical masks by healthcare providers at all times while inside long-term care facilities (LTCFs), including in breakrooms or other spaces where they might encounter other people. Healthcare providers who are in close contact with a LTCF resident with suspected or confirmed coronavirus infection must use a NIOSH-approved N95 filtering facepiece respirator or equivalent or higher-level respirator, as required by OSHA’s Respiratory Protection standard. The guidance further indicates that employers should reassess their engineering and administrative controls, such as ventilation and practices for physical distancing, hand hygiene, and cleaning/disinfecting surfaces, to identify changes that could avoid over-reliance on respirators and other personal protective equipment.
HHS, DoD, and Operation Warp Speed (OWS) announced agreements with CVS and Walgreens to provide and administer COVID-19 vaccines to residents of long-term care facilities (LTCF) nationwide with no out-of-pocket costs. The program is:
– Free of charge to facilities.- Available for residents in all long-term care settings, including skilled nursing facilities (SNF), nursing homes, assisted living facilities, residential care homes, and adult family homes.
– Available to all remaining LTCF staff members who have not been previously vaccinated for COVID-19 (e.g., through satellite, temporary, or off-site clinics).
– Available in most rural areas that may not have an easily accessible pharmacy.
The pharmacies will receive and manage vaccines and associated supplies (e.g., syringes, needles, and personal protective equipment); ensure cold chain management for vaccine; provide on-site administration of vaccine; and report required vaccination data (including who was vaccinated, with what vaccine, and where) to the state, local, or territorial, and federal public health authorities within 72 hours of administering each dose.Starting October 19, 2020, LTCFs will be able to opt in and indicate which pharmacy partner their facility prefers to have on-site. LTCFs are not mandated to participate in this program and can request to use their current pharmacy contracts to support COVID-19 vaccination. Nursing homes can sign up via the National Healthcare Safety Network and assisted living facilities can sign up via an online survey they will receive.
CMS announced an update to its methodology for cascading testing requirements for nursing homes based on the community-specific rate of COVID-19 positivity. Under guidance CMS issued on August 26, nursing homes must test staff: monthly if the facility’s county positivity rate is less than 5%; weekly if the county positivity rate is between 5-10%; and twice weekly if the county positivity rate exceeds 10%. In response to concerns from governors of rural states that the frequency guidelines did not work well for rural areas that had low utilization of COVID-19 tests, CMS revised its methodology such that:
– Counties with 20 or fewer tests over 14 days are not required to test staff more frequently than once per month, regardless of county test positivity rates
– Counties with both fewer than 500 tests and fewer than 2,000 tests per 100,000 residents, and greater than 10 percent positivity over 14 days are not required to test staff more frequently than once per week
CMS issued new guidance for nursing homes on visitation policies during the COVID-19 pandemic, revising previously issued guidance in March and May. The September 17 guidance encourages nursing homes to facilitate outdoor visitation broadly and indoor visitation in the event of no new onset of COVID-19 cases within the past 14 days (provided some restrictions on the number of visitors and movement through the facility). The guidance also expands upon previous guidance, which focused primarily on end-of-life situations, providing additional examples of compassionate care situations for which visitation should be allowed.
Notably, the guidance clarifies the flexibilities that facilities have to restrict visitation due to the community- or facility-specific COVID-19 transmission but prohibits facilities from restricting visitation without a reasonable clinical or safety cause, consistent with §483.10(f)(4)(v). Failure to facilitate visitation, without adequate reason related to clinical necessity or resident safety, would constitute a potential violation of 42 CFR 483.10(f)(4), and the facility would be subject to citation and enforcement actions.The guidance further indicated that facilities may apply to use Civil Monetary Penalties (CMP) funds to help facilitate in-person visits, such as for the purchase of tents for outdoor visitation and/or clear dividers to create a physical barrier to reduce the risk of transmission during in-person visits. Funding for tents and clear dividers is also limited to a maximum of $3,000 per facility.
HHS’ Office of the Inspector General (OIG) released an updated list of its Active Work Plan Items reflective of OIG’s audits, evaluations, and inspections that are underway or planned in determination of providers’ compliance with temporary authorities during the COVID-19 public health emergency. The newly-announced items include:
– COVID-19 Testing Data From Federal Programs. The CARES Act created the Pandemic Response Accountability Committee (PRAC) in order to promote transparency, support oversight, and detect/prevent fraud, waste, abuse, and mismanagement in the federal government’s COVID-19 response. PRAC members include Offices of Inspectors General (OIG) from the Departments of Defense (DoD), Education, Health and Human Services (HHS), Labor (DOL), and Veterans Affairs (VA), as well as the Office of Personnel Management (OPM). HHS-OIG will work with PRAC to produce a data brief describing COVID-19 testing in federal health-related programs managed or operated by these agencies to help provide transparency and inform policymakers about COVID-19 testing resources in federal programs.
– HHS and ASPR Actions Related to Resources, Supplies, and Treatments Needed to Address COVID-19. HHS OIG will examine actions taken by HHS, including the Office of Assistant Secretary for Preparedness and Response (ASPR), to protect public health in response to the COVID-19 pandemic. The announcement notes that HHS may take a variety of actions, and specifically notes actions related to resources, supplies, and treatments needed to address COVID-19.
– Infection Control at Home Health Agencies During the COVID-19 Pandemic. HHS OIG will interview corporate officers from the three Home Health Agency providers with the largest market share in 2019 as well as HHAs that have recently been cited by CMS for infection control and prevention deficiencies to determine the extent to which their infection control and prevention policy and procedures comply with CMS guidance regarding COVID-19.(Note, OIG references CMS’ March 10 CMS State Survey Directors Letter, “Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Home Health Agencies (HHAs).”)
HHS announced the details of its $2 billion performance-based incentive payment distribution to nursing homes, a component of its previously announced $5 billion Provider Relief Fund allocation for nursing homes.
In order to qualify for payments under the incentive program, a facility must have an active state certification as a nursing home or skilled nursing facility (SNF) and receive reimbursement from CMS. HHS will administer quality checks on nursing home certification status through the Provider Enrollment, Chain and Ownership System (PECOS)and facilities must also report to at least one of the following data sources that will be used to establish eligibility and collect necessary provider data to inform payment: Certification and Survey Provider Enhanced Reports (CASPER), Nursing Home Compare (NHC), and Provider of Services (POS). The incentive payment program will entail four performance periods (September, October, November, December) with $500 million in distributions for each period.
Using CDC’s Community Profile Reports (CPRs) to determine baselines for COVID-19 infections per capita and COVID-19 test positivity rates, HHS will measure facilities’ performance based on: (1) ability to keep new COVID infection rates low among residents; and (2) ability to keep COVID mortality low among residents. To measure facility COVID-19 infection and mortality rates, the incentive program will utilize data from the National Healthcare Safety Network (NHSN) Long-Term Care Facility (LTCF) COVID-19 module. CMS issued guidance in early May requiring that certified nursing facilities submit data to the NHSN COVID-19 Module (see Column J).(On August 27, HHS announced it had distributed the first $2.5 billion in payments to nursing homes to help with upfront COVID-19-related expenses for testing, staffing, and personal protective equipment (PPE) needs.)
CMS issued guidance in a PowerPoint format for nursing homes, highlighting its recent actions relevant for nursing homes, including:
The Inception of its National COVID-19 Training for Frontline Nursing Home Staff and Management. As previously announced on August 25, CMS reiterated its provision of five training modules designed for frontline clinical staff as well as ten designed for nursing home management. Supplemental to the training, CMS is hosting weekly webinars every Thursday between 4:00 to 5:00 pm ET that are available via the Quality Improvement Organization (QIO) homepage.
Testing & Reporting Requirements Introduced by CMS’s Third Interim Final Rule with Comment Period (IFC). Previously issued on August 25, CMS reiterated key provisions for nursing homes included in its third IFC related to the COVID-19 public health emergency: (1) mandatory testing requirements for staff and residents in nursing homes; and (2) mandatory reporting requirements for hospitals and CLIA-certified labs. The guidance also outlines the ways in which nursing homes may report COVID-19 testing data to the CDC. CMS reiterated recent guidance on the use of antigen, point-of-care testing in nursing homes as a means to augment other testing efforts, especially in settings where testing capacity is limited or testing results are delayed. The guidance further indicated that CMS is assessing available methods to gather data for determining compliance with the laboratory reporting mandate. Failure to report SARS-CoV-2 positive and negative results will result in civil money penalties of $1,000 for the first day of noncompliance and $500 for each additional day of noncompliance.
MS released the independent Coronavirus Commission for Safety and Quality in Nursing Homes (Commission) report. The Commission was convened to solicit lessons learned from early experience during the pandemic and develop recommendations for future actions to improve infection prevention and control measures, safety procedures, and quality of life for residents of nursing homes. Alongside the report, CMS issued a response to the report, which compares the Commission’s recommendations to a list of actions the agency has taken to date; the response does not describe which, if any, of the recommendations issued by the Commission it plans to build upon. CMS also prepared and issued a compilation of guidance and updates for nursing homes during COVID-19.
The 186-page final Commission report submitted by the Commission to CMS includes 27 recommendations and accompanying action items organized into 10 themes with recommendations and associated action steps. These themes and some of the key recommendations include:
– Testing and screening: Develop and execute a national strategy with federal partners and SLTT authorities for testing and delivering rapid turnaround of results
– Equipment and PPE: Assume responsibility for a collaborative process with federal and SLTT partners regarding PPE procurement and availability; issuing specific guidance on the use, decontamination, and reuse of PPE; and issuing guidance on training on proper use of PPE and equipment, as needed
– Cohorting: Update cohorting guidance to balance resident and staff wellbeing with infection prevention and control; update cohorting guidance and reimbursement policies to reflect differences in nursing home resources
– Visitation: Emphasize visitation as a vital resident right and update and release consolidated, evidence-based guidance on safely increasing controlled, in-person visitation prior to Phase 3 re-opening; issue guidance on effectively planning for and implementing virtual visitation tools and techniques; provide resources to help facility staff assess the pychological wellbeing of residents; and streamline these and other resources into a single visitation source document
– Communication: increase specificity and expand breadth of guidance on communications between nursing home staff, residents, and families
– Workforce – stopgaps for resident safety: Mobilize resources to support a fatigued nursing home workforce, provide equity-oriented guidance that allows nursing home workforce to safely continue working in multiple nursing homes; support 24/7 registered nurse staffing resources at nursing homes in the event of a positive COVID-19 test within that facility, and leverage certified infection preventionists
– Workforce – strategic reinforcement: Catalyze interest in the certified nurse assistant profession and create a national CNA registry; update regulations to allow more fully qualified infection preventionists to be available in nursing homes; catalyze an overhaul of the workforce ecosystem in partnership with federal, SLTT, and other partners and convene a Long-Term Care Workforce Commission
– Technical assistance and quality: Increase availability of collaborative, on-site, data-driven and outcomes-oriented support prior to, during, and after a public health emergency
– Facilities: Identify and share with nursing homes short-term facility design enhancements to address pandemic-related risks; establish a national forum to share best practices and recommendations; establish long-term priorities and seek appropriate funding streams for redesign/facility strengthening
– Data: Standardize nursing home data; create an easy-to-use interactive technical infrastructure for nursing homes that streamlines reporting, dissemination of guidance, etc; enhance HIT interoperability to facilitate better communication, quality measurement standards, and data sharing
On July 31 and August 7, HHS announced that it planned to distribute an additional $5 billion in Provider Relief Fund payments to skilled nursing facilities, in two ~$2.5 billion tranches. On August 27, HHS announced it has distributed the first approximately $2.5 billion to over 15,000 skilled nursing facilities and nursing homes with 6 or more certified beds. Although HHS has not provided additional information about the eligibility criteria for this distribution, it appears to vary from the criteria that HHS applied to the first $4.9 billion Skilled Nursing Facility payments distributed earlier this summer. HHS indicated that those payments were distributed to approximately 13,000 facilities as compared to the 15,000 facilities that received this payment. Eligible facilities received a per-facility base payment of $10,000 plus a per-bed payment of $1,450. HHS published a state-by-state breakdown of the payments.
In its press release, HHS indicates that this $2.5 billion distribution is intended to support increased testing, staffing, PPE needs, and COVID isolation facilities, but it is unclear whether HHS will set specific parameters for eligible uses of this distribution of the Provider Relief Fund. HHS also noted that it plans to distribute a another $2 billion later this fall based on certain performance indicators that will be shared in the future. (It is unclear how it will distribute the remaining approximately $500 million of its distribution said to amount to $5 billion in total).
In coordination with its release of its third interim final rule with comments (IFC) related to the COVID-19 public health emergency, CMS issued guidance that builds upon the nursing home COVID-19 testing requirements established in the IFC. The guidance sets out facility requirements for testing resident and staff based on “testing triggers” such as a symptomatic individual being identified, an outbreak (i.e., any new case arises in the facility), or routine testing. The guidance requires that:• Staff and residents with signs/symptoms of COVID-19 are tested;• In the event of an outbreak, all staff and residents that previously tested negative should be retested every 3 to 7 days until there are no new cases for a period of at least 14 days; • Routine testing should be completed for staff, but not residents unless the resident “leaves the facility routinely.” Routine testing for staff should be conducted in accordance with parameters set forth related to the weekly positivity rate in the county in which the facility is located.The guidance also includes: other testing considerations; information about the steps facilities should take to address individuals who refuse testing; information about conducting, documenting, and reporting testing; an updated COVID-19 focused survey for nursing homes; and additional resources.
CMS issued an interim final rule with comments (IFC) related to the COVID-19 public health emergency. The rule includes a focus, in particular, on COVID-19-related testing and reporting requirements for nursing homes and hospitals. It also includes modifications to quality reporting program requirements impacting plans and providers.Key areas addressed by the rule include:
CMS’s Center for Consumer Information and Insurance Oversight (CCIIO) issued a fact sheet describing the applicability of the IFC to individual and small group market health plan issuers. The fact sheet describes the impact of the IFC on Medical Loss Ratio (MLR) reporting and rebate requirements for issuers electing to provide temporary premium reductions.The IFC will become effective upon its pending publication to the Federal Register through the duration of the Public Health Emergency. Public comment will be available for 60 days upon the IFR’s publication to the Federal Register.
HHS provided new information about the Provider Relief Fund $5 billion allocation for nursing homes and long-term care facilities, first announced in July. Specifically, an initial $2.5 billion distribution will support increased testing, staffing, PPE needs, and COVID isolation facilities. The balance will be distributed based on nursing home performance, particularly a nursing home’s ability to minimize COVID spread and COVID-related fatalities among its residents with consideration of the prevalence of the virus in the nursing home’s local geography. According to HHS, the initial $2.5 billion distribution will occur in mid-August, and be followed by the performance-based distributions throughout the fall. HHS likely will provide additional information about the methodology for determining eligibility and payment for these funds via its Provider Relief Fund General Information page and/or FAQs.
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 FAQs on COVID-19 testing in SNFs and nursing homes, which primarily provide additional information about the testing platforms and tests being distributed by CMS to certain facilities. The FAQs address:• Plans for distribution of testing platforms and FDA-authorized antigen diagnostic tests, including which facilities will receive them and the number of tests they will receive• Training for nursing home staff to administer COVID-19 tests• Required safety precautions for performing COVID-19 tests• Requirements for reporting results of COVID-19 tests
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.
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.