The Nebraska Association For Home Healthcare & Hospice is concerned about COVID-19, also known as Coronavirus Disease, and how it will impact members and your patients. First discovered last December (2019), COVID-19 is a novel virus first identified in a group of pneumonia cases in China. The coronavirus continues to spread around the world and, as with any other newly identified virus, there is much to learn about the disease process, mode of transmission, incubation period, symptoms, and treatment.

At this point in time the home care and hospice care industry should be preparing for altered and crisis standards of care. A review of your pandemic plan should currently be underway and response processes should be updated. The home care and hospice care practice is dependent on personnel, so up-to-date information and training is essential.

Much is still unknown, but the following resources have been provided for members and visitors of the home health and hospice community. This page will continue to be updated as more information is made available.

New on the Page (Updated May 11, 2020):

  • NAHC CARES Act Emergency Funds: How to Achieve Accountability and Compliance Part 2
  • NAHC Home Care & Hospice COVID-19 Town Hall Part 6
  • CMS Issues Additional Home Health and Hospice 1135 Waivers
  • National Study Shows Home Health Care in a Fragile State
  • NAHC Needs Hospice Input on Impact of COVID-19
  • Recommended Operations Protocols for Dealing with COVID-19
  • CDC Revised Criteria for Healthcare Workers to Return to work

 

NAHC REPORT: Alleviating the Burden on Hospitals by Ensuring Safe Care at Home

Please reach out to hospitals in your local areas and encourage those hospitals to partner with home health agencies during this crisis. A sample letter to share with hospitals is available for reference.



CRITICAL NOTICE: Hospice and other health care workers are listed as exceptions to visitor restrictions and subject to the same screening as all other workers entering a facility. For reference: 


Blue Cross Blue Shield of Nebraska COVID-19 and Telehealth Update (March 26)


OSHA Guidance on Respirator Decontamination 

The Occupational Safety & Health Administration (OSHA) released interim guidance on decontamination of respirators in health care. This is the latest series of enforcement memos OSHA has issued to address workplace exposure to coronavirus. Home heath and hospice providers should review this information, along with the Centers for Disease Control's Decontamination and Reuse of Filtering Facepiece Respirators information.


Steps to help prevent the spread of COVID-19 if you are sick: Click here.

Cleaning and Disinfecting Your Home: Click here.


Family Resources for Dealing with COVID-19

Additional resources: 


Coronavirus Products and Resources

McKesson Medical-Surgical Supplier Updates

  • To read McKesson's letter to customers addressing supply challenges, the updated allocation strategy and more, click here.
  • McKesson's new COVID-19 Safe Zone Delivery Protocols are available here.

BONUS: 3M N95 Respirator Decontamination Methods: Click here.

        3M Disinfection of Filtering Facepiece Respirators: Click here.


NAHC Coronavirus Products and Resources Page: https://www.nahc.org/resources-services/coronavirus-resources/covid19-partners/


Health Protocols

According to the Centers for Disease Control and Prevention (CDC), there is currently no vaccine to prevent COVID-19. The best way to prevent illness is to avoid being exposed to this virus. The CDC recommends everyday preventive actions to help prevent the spread of respiratory diseases, including:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces.
  • Follow CDC’s recommendations for using a facemask (facemasks are only needed for those who show symptoms of coronavirus).
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.


National Association for Home Care & Hospice

National Association for Home Care & Hospice (NAHC) has created a new resource page specifically for helping the home care and hospice community remain informed and deal safely and appropriately with the spread of COVID-19, the Coronavirus.

The COVID-19 Resource Page will be updated constantly until this crisis has passed and it will be populated with the latest information, guidance, and best practices. In order to maximize exposure to education and promote the general welfare, the information on this page will be available and free to everyone.

Right now, on the COVID-19 Resource Page, you will find resources from the Centers for Disease Control (CDC) and the World Health Organization (WHO), as well as NAHC’s COVID-19 checklist for home care and hospice and disease response and management, in cooperation with disaster preparedness and infection control expert Barbara Citarella and the LHC Group, respectively.

The most recent addition is NAHC's Coronavirus Products and Services Resources Page.


NEW: CARES Act Emergency Funds: How to Achieve Accountability and Compliance Part 2

Handout:

Link to handout: https://www.nahc.org/wp-content/uploads/2020/05/WebEvent_20-05-07-1430_Handout.pdf

Recording URL:

https://nahc.webex.com/nahc/lsr.php?RCID=6a6e7a33572a2ebd170b637b00deef0f


NEW: Home Care & Hospice COVID-19 Town Hall Part 6

Handout: 

Link to handout: https://www.nahc.org/wp-content/uploads/2020/05/WebEvent_20-05-06-1300_Handout.pdf

Recording URL:

https://nahc.webex.com/nahc/lsr.php?RCID=70c30a5bba885a009c90219036b8d080


National Study Shows Home Health Care in a Fragile State

A national survey of home health agencies (HHA) indicate the COVID-19 pandemic has severely disrupted the care delivery system, bringing significant financial pressures throughout the country. The impact is due to pandemic-triggered changes affecting services to the usual 3.5 million Medicare beneficiaries who receive care in the home as well as the new patient population of COVID-19 patients.

Nationwide, 41.5 percent of HHAs report serving actively infected COVID-19 patients. In the “hot spot” of New York/New Jersey, 85.71 percent of HHAs report serving such patients.

There is a lot more in this study and it is both stunning and sobering. Clearly, home care is on the front lines of the COVID-19 pandemic and it is having a massive impact on the industry. Please share this with your professional circles, the media, and anyone else you think appropriate.

GET THE WHOLE STORY @ NAHC REPORT
***

NAHC Needs Hospice Input on Impact of COVID-19


In response to the COVID-19 pandemic, hospice providers have dealt with numerous operational challenges. The impact of the public health emergency has varied widely depending on the location and structure of the hospice program. While Congress and the Administration have responded with the creation of regulatory flexibilities and financial support that is deeply appreciated, it is anticipated that the public health emergency will have a continuing impact on staffing, revenues, care costs, and other operational concerns.

As the National Association for Home Care & Hospice (NAHC) continues its efforts to ensure hospice and palliative care providers receive the support they need from policymakers, we need information regarding how hospice programs are continuing to be impacted by COVID-19. For this reason, NAHC has developed a survey intended to help assess the expected impact of COVID-19 on hospice organizations.  Data from this survey will be used to support advocacy with Congress and the Administration, and to inform policy recommendations and priorities.

We strongly urge hospices to participate in this surveyIt is expected that the answers you provide will reflect best estimates of the impact rather than hard data and will be based on current expectations.  For this reason, we believe that the survey can be completed in a short period of time.

All responses to the survey will be kept strictly confidential and no organizations will be identified; nor will any information be shared that could potentially identify any of the participating organizations in this survey. Thank you for participating in this important survey!
***

Recommended Operations Protocols for Dealing with COVID-19

The Home Care Steering Committee and other contributing expert members have created Recommended Operations Protocols for home care agencies dealing with COVID-19 and we strongly encourage all NAHC members to study this document closely.

The Protocols cover topics including, but not limited to:

  • Management action steps;
  • Communication to clients and patients;
  • Client screening;
  • Patient/Client training;
  • Direct care worker training;
  • Personal Protective Equipment;
  • Response to suspected Covid-19 in patient home;
  • How to cope with emotional reactions to stress situations, such as a pandemic;
  • and much, much more.

This is a must-read resource for anyone in home care.

READ MORE @ NAHC REPORT!

 

Nebraska Department of Health and Human Services Division of Public Health

The Nebraska DHHS Division of Public Services has made information available on its website, http://dhhs.ne.gov/ and has a dedicated page, http://dhhs.ne.gov/Pages/Coronavirus.aspx.

The site includes Health Care Provider Information and updated Public Service Messages.

Nebraska DHHS announced an online form is available for healthcare providers to request PPE if they are at a critical point of one week’s supply: https://form.jotform.com/nebraskadhhs/pperequestform.

Please complete and submit the Nebraska DHHS PPE Needs Form, available here, to your public health department.

A Public Health Department Contact list is available here.


Executive Orders (Full list at bottom of linked page)

CMS response to Nebraska 1135 waiver request (April 2)

General Statewide Telehealth FAQ relating to COVID-19 with code information (Updated April 1, 2020) 

The Medicaid COVID-19 Provider Bulletin (Updated March 17) is available here, http://dhhs.ne.gov/Pages/Medicaid-Provider-Bulletins.aspx.

An information hotline is also available from 8 a.m. CST (7 a.m. MST) - 8 p.m. CST (7 p.m. MST) at (402) 552-6645.


Federal Agencies

NEW SECTION: CMS Issues Additional Home Health and Hospice 1135 Waivers

On April 30, the Centers for Medicare & Medicaid Services (CMS) issued additional waivers under Section 1135 of the Stafford Act to provide flexibilities to health care providers.  Additional information about the waivers is available HERE, and also accessible via the Current Emergencies  or Coronavirus Waivers & Flexibilities websites.  Newly-issued waivers applicable to hospice programs are listed below; these are effective retroactive to March 1, 2020, and until the end of the public health emergency.

New Waivers Applicable to Home Health:

Training and Assessment of Aides: (New since 4/21 Release) CMS is waiving the requirement at 42 CFR §484.80(h)(1)(iii) for HHAs, which require a registered nurse  or other appropriate skilled professional (physical therapist/occupational therapist, speech language pathologist) to make an annual onsite supervisory visit (direct observation) for each aide that provides services on behalf of the agency. In accordance with section 1135(b)(5) of the Act, CMS is postponing completion of these visits. All postponed onsite assessments must be completed by these professionals no later than 60 days after the expiration of the Public Health Emergency (PHE). 

Quality Assurance and Performance Improvement (QAPI). (New since 4/21 Release) CMS is modifying the requirement at 42 CFR §484.65 for HHAs, which requires HHAs to develop, implement, evaluate, and maintain an effective, ongoing, HHA-wide, data-driven QAPI program. Specifically, CMS is modifying the requirements at §484.65(a)–(d) to narrow the scope of the QAPI program to concentrate on infection control issues, while retaining the requirement that remaining activities should continue to focus on adverse events. This modification decreases burden associated with the development and maintenance of a broad-based QAPI program, allowing the providers to focus efforts on aspects of care delivery most closely associated with COVID-19 and tracking adverse events during the PHE. The requirement that HHAs maintain an effective, ongoing, agency-wide, data-driven quality assessment and performance improvement program will remain.

12-hour Annual In-Service Training Requirement for Home Health Aides. (New since 4/21 Release) CMS is modifying the requirement at 42 C.F.R. §484.80(d) that home health agencies must assure that each home health aide receives 12 hours of in-service training in a 12-month period. In accordance with section 1135(b)(5) of the Act, CMS is postponing the deadline for completing this requirement throughout the COVID-19 PHE until the end of the first full quarter after the declaration of the PHE concludes. This will allow aides and the registered nurses (RNs) who teach in-service training to spend more time delivering direct patient care and additional time for staff to complete this requirement.

Detailed Information Sharing for Discharge Planning for Home Health Agencies. (New since 4/21 Release) CMS is waiving the requirements of 42 CFR §484.58(a) to provide detailed information regarding discharge planning, to patients and their caregivers, or the patient’s representative in selecting a post-acute care provider by using and sharing data that includes, but is not limited to, (another) home health agency (HHA), skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and long-term care hospital (LTCH) quality measures and resource use measures.

·         This temporary waiver provides facilities the ability to expedite discharge and movement of residents among care settings. CMS is maintaining all other discharge planning requirements.

Clinical Records (New since 4/21 Release) In accordance with section 1135(b)(5) of the Act, CMS is extending the deadline for completion of the requirement at 42 CFR §484.110(e), which requires HHAs to provide a patient a copy of their medical record at no cost during the next visit or within four business days (when requested by the patient). Specifically, CMS will allow HHAs ten business days to provide a patient’s clinical record, instead of four.


New Waivers Applicable to Hospice Providers:

Annual Training. (New since 4/21 Release) CMS is modifying the requirement at 42 CFR §418.100(g)(3),which requires hospices to annually assess the skills and competence of all  individuals furnishing care and provide in-service training and education programs where required. Pursuant to section 1135(b)(5) of the Act, we are postponing the deadline for completing this requirement throughout the COVID-19 PHE until the end of the first full quarter after the declaration of the PHE concludes. This does not alter the minimum personnel requirements at 42 CFR §418.114. Selected hospice staff must complete training and have their competency evaluated in accordance with unwaived provisions of 42 CFR Part 418.


CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program

CMS announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to healthcare providers and suppliers through these programs. CMS had expanded these temporary loan programs to ensure providers and suppliers had the resources needed to combat the beginning stages of the COVID-19. Funding will continue to be available to hospitals and other healthcare providers on the front lines of the coronavirus response primarily from the Provider Relief Fund.

 

Press Release

 

 

Infection Control Guidance to Home Health Agencies on COVID-19

   

CMS issued guidance to respond to questions from Medicare & Medicaid Home Health Agencies and Religious Nonmedical Healthcare Institutions. The guidance addresses the COVID-19 outbreak and minimizing transmission to other individuals.

 

Guidance


CMS has issued the proposed FY2021 hospice rule

The hospice proposed rule for FY2021 was just released. It will be published in the Federal Register soon and the temporary link is:  https://s3.amazonaws.com/public-inspection.federalregister.gov/2020-07959.pdf

NAHC staff are analyzing the proposals now and will provide a detailed summary in the coming days. A quick summary is below.

This proposed rule would update the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2021.This rule also proposes changes to the hospice wage index by adopting the most recent Office of Management and Budget statistical area delineations, with a 5 percent cap on wage index decreases. Finally, this proposed rule summarizes the changes to the hospice election statement finalized in the FY 2020 Hospice Wage Index and Rate Update final rule and effective for October 1, 2020; and provides hospices with a model election statement and sample addendum.  The proposed FY 2021hospice payment update percentage is 2.6 percent.


CMS Issues Proposed FY2021 Hospice Payment Rule, Election Statement and Addendum Requirements 

For a summary prepared by NAHC staff of the FY2021 proposed hospice rule, click here.


CMS releases additional 1135 waivers for Home Health and Hospice

CMS has posted new waiver authorities for hospice and home health providers the following link: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf. These waivers are effective retroactive to March 1 and are among changes NAHC has sought relief on.

Home health

  • Allow OTs to conduct the initial and comprehensive assessment for all patients

Hospice

  • Waive the 12 hour in-service requirement
  • Allow use of pseudo-patients for aide competency testing


FDA Guidance - Use of KN-95 masks, or other respirators, in lieu of N-95 masks (Issued April 5)

The FDA also issued guidance to provide a policy to help expand the availability of general use face masks for the general public and respirators for health care professionals during this pandemic. The guidance applies to KN95 respirators as well. It explains that for the duration of the pandemic, when FDA-cleared or NIOSH-approved N95 respirators are not available, the FDA generally would not object to the importation and use of respirators without an EUA, including KN95 respirators, if they are on the Centers for Disease Control and Prevention (CDC) list of respirator alternatives during the COVID-19 pandemic. Although not required, if a KN95 respirator does not have an EUA, importers may want to take appropriate steps to verify authenticity of these products.


CDC Revised Criteria for Healthcare Workers to Return to Work

The CDC revised its criteria for healthcare workers to return to work. You can read about these changes here, https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html.


CDC Issues Guidance on Strategies to Optimize PPE & Equipment

On March 31, the Centers for Disease Control and Prevention (CDC) issued guidance to health care professionals on Decontamination and Reuse of Filtering Facepiece Respirators using Contingency and Crisis Capacity Strategies. While disposable filtering facepiece respirators are not approved for routine decontamination and reuse as a standard of care, such action may be necessary as a crisis capacity strategy. This guidance discusses crisis standards of care for such decontamination and information regarding various methods for decontamination.

 


Department of Labor Announces New Paid Sick Leave and Expanded FMLA Implementation


The U.S. Department of Labor today announced new action regarding how American workers and employers will benefit from the protections and relief offered by the Emergency Paid Sick Leave Act and Emergency Family and Medical Leave Expansion Act, both part of the Families First Coronavirus Response Act (FFCRA). The department’s Wage and Hour Division (WHD) posted a temporary rule issuing regulations pursuant to this new law, effective , April 1, 2020.

FFCRA enables employers to keep their workers on their payrolls, while at the same time ensuring that workers are not forced to choose between their paychecks and the public health measures needed to combat the virus. WHD administers the paid leave portions of the FFCRA.

WHD is posting a recorded webinar on Friday, April 3, 2020, to provide interested parties a more in-depth description and help them learn more about the FFCRA. To view the webinar, visit 
www.dol.gov/agencies/whd/pandemic.

Home Health Grouper Updated with New COVID-19 and Vaping-Related Disorder Diagnosis Codes

The Centers for Disease Control and Prevention (CDC) recently announced a change to the effective date for the new ICD-10 diagnosis code for COVID-19 to April, 1 2020, and issued supplemental guidance. The Centers for Medicare & Medicaid Services (CMS) indicated there would be updates to previously released transmittals to reflect this change. This happened on April 1 when CMS posted an updated Transmittal 10025/Change Request (CR) 11656. This CR updates the version of the Home Health Grouper software used in Original Medicare claims processing. The new version includes the diagnosis codes recently created for vaping related disorder and for the 2019 Novel Coronavirus (COVID-19). The implementation date is April 6, 2020.


The Centers for Medicare & Medicaid Services issued Frequently Asked Questions (FAQs) to Ensure Individuals, Issuers and States have Clear Information on Coverage Benefits for the 2019 Novel Coronavirus (COVID-19) outbreak. This action is part of the broader, ongoing effort by the White House Coronavirus Task Force to ensure that all Americans – particularly those at high-risk of complications from the COVID-19 virus – have access to the health benefits that can help keep them healthy while helping to contain the spread of this disease.

CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19 (March 22, 2020): https://www.cms.gov/newsroom/press-releases/cms-announces-relief-clinicians-providers-hospitals-and-facilities-participating-quality-reporting

Medicare Provider Enrollment Relief FAQs and Expedited Toll-Free Hotlines (Updated March 23, 2020)https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf

FAQs for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies (Updated March 18, 2020)https://www.medicaid.gov/state-resource-center/downloads/covid-19-faqs.pdf

Medicare Telehealth FAQs (Updated March 17, 2020)https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

FAQs for EHB (Updated March 12, 2020): https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/EHB-Benchmark-Coverage-of-COVID-19.pdf

CMS is also posting FAQs to the Medicaid.gov website to aid state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their response to COVID-19 in its continuing efforts to protect the health and safety of providers and patients.

Press release: https://www.cms.gov/newsroom/press-releases/cms-publishes-first-set-covid-19-frequently-asked-questions-faqs-state-medicaid-and-childrens-health.

FAQs for State Medicaid and CHIP agencies: https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/covid19/index.html.

These FAQs, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.


Webinars

Home Care & Hospice COVID-19 Town Hall Part 3 (Free Webinar Recorded April 8)

Recording URL: https://nahc.webex.com/nahc/lsr.php?RCID=c7084e43547c6f84dc050be7ad917d8e

All current information can also be found in the following link: https://www.nahc.org/webinar-home-care-and-hospice-covid-19-town-hall/

Link to handout: https://www.nahc.org/wp-content/uploads/2020/04/WebEvent_20-04-08-1300_Handout.pdf

Content Update Alert:

We received a question about the interaction of the FFCRA credits and the PPP loans.

Please reference the slides from the presentation on the FFCRA provisions.

In addition, here is one of the questions from the recently released FAQs.

8. Question: Do PPP loans cover paid sick leave?

Answer: Yes. PPP loans covers payroll costs, including costs for employee vacation,
parental, family, medical, and sick leave. However, the CARES Act excludes qualified
sick and family leave wages for which a credit is allowed under sections 7001 and 7003
of the Families First Coronavirus Response Act (Public Law 116–127).

20. Question: The amount of forgiveness of a PPP loan depends on the borrower’s payroll costs over an eight-week period; when does that eight-week period begin?

Answer: The eight-week period begins on the date the lender makes the first disbursement of the PPP loan to the borrower. The lender must make the first disbursement of the loan no later than ten calendar days from the date of loan approval.


NEW: Leading in the Time of COVID-19 (Free Webinar)

Thursday, April 9, at 12 p.m. (Central) 

During this challenging time, it is crucial for leadership to present a calm demeanor and support the physical and psychological health of our employees. This webinar will focus on operational actions you can take in preparation for the weeks and months and on ways to keep your caregivers safe, happy, and on your team for the long haul! Click here for more information or to register.


COVID-19: The Impact on Home Care and Hospice (For Promo Code and pay only $40, contact NEhomehealthcareandhospice@assocoffice.net)

Topics of the webinar include:

  • Describe the new coronavirus (COVID-19) and discuss where it came from.
  • List the signs and symptoms of COVID-19.
  • Describe the infection control precautions that should be followed to prevent the spread of COVID-19.
  • List the steps to take if a client begins to show symptoms of coronavirus.

Home Care Pulse and In the Know are providing a free 30-minute training for non-medical caregivers on COVID-19: Download Free 30-Minute Coronavirus Training

Contact Nehomehealthcareandhospice@assocoffice.net if you have questions or concerns about scarcity of supplies, staffing numbers and alternatives, or other management issues.


Additional Resources:

U.S. Department of Health and Human Services:

Centers for Disease Control and Prevention:

What you should know:

Situation Updates:

Information for Businesses:

Information for Healthcare Providers, First Responders, and Research Facilities:

Information for Families and Households:

Information for Community Events and Gatherings:


Contact Us

Address:  3901 Normal Blvd., Suite 100
Lincoln, NE, 68506-5200


Phone:  (402) 423-0718


Fax:  (402) 476-6547


Email:  nebraskahomecare@assocoffice.net




About Us

The Nebraska Association For Home Healthcare & Hospice advocates for its members, in order to represent their interests and protect the services provided to beneficiaries. We depend on members to voice their opinions, share stories and insight to help us protect those rights and represent their businesses. The association strives to positively influence public policy efforts on behalf of members at the local, state and federal levels, provides regulatory and legislative updates and hosts professional development events to help ensure members receive up-to-date education in order to deliver care and services to their clients.

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