Senate Bill 690 - $2/Hr Wage Increase Updated FAQs

On Tuesday July 21, 2020 the Michigan Department of Health & Human Services updated the FAQs related to the direct care worker wage increase originating from SB 690.

 

 Three specific items have been updated:

• Question #1, d clarifies that only facilities certified in either Medicaid or Medicare are eligible for the pass through payments.
• Question #4, a indicates overtime (OT) is eligible for reimbursement, and clarifies how OT should be applied under the "8 and 80" system as well as employees that fall outside the "8 and 80" system.
• Question #5, c clarifies that wage levels in effect on June 30, 2020 should be utilized to determine the adjustment for the $2/hour increase.

CDC Updates Guidance on Transmission Based Precautions, Duration of Isolation, and Return to Work

On Friday July 17, 2020 the Centers for Disease Control & Prevention (CDC) issued significant changes to several areas of guidance related to COVID-19.  These revisions impact guidance related to the discontinuation of transmission based precautions disposition of patients with COVID-19 in healthcare settings, moving away from a test based strategy to discontinue precautions.

Except for rare situations, a test-based strategy is no longer recommended to determine when to discontinue Transmission-Based Precautions for individuals who had tested positive for COVID-19.  Rather, CDC recommends following a Symptom-Based Strategy: 

• For Patients with mild to moderate illness who are not severely immunocompromised:
• At least 10 days have passed since symptoms first appeared and
• At least 24 hours have passed since last fever without the use of fever-reducing medications and
• Symptoms (e.g., cough, shortness of breath) have improved

Note:  For patients who are not severely immunocompromised and who were asymptomatic throughout their infection, Transmission-Based Precautions may be discontinued when at least 10 days have passed since the date of their first positive viral diagnostic test.
 

For Patients with severe to critical illness or who are severely immunocompromised:

• At least 20 days have passed since symptoms first appeared and
• At least 24 hours have passed since last fever without the use of fever-reducing medications and
• Symptoms (e.g., cough, shortness of breath) have improved
  

Other symptom-based criteria were modified as follows:

• Changed from "at least 72 hours" to "at least 24 hours" have passed since last fever without the use of fever-reducing medications during the time-based time window.
• Changed from "improvement in respiratory symptoms" to "improvement in symptoms" to address expanding list of symptoms associated with COVID-19
  

CDC also revised the Criteria for Return to Work for Healthcare Personnel with COVID-19 Infection. The new criteria mirror those for residents and include:

• Except in rare situations, test-based strategy is no longer recommended to determine when to allow healthcare personnel (HCP) to return to work.
• For HCP with severe to critical illness or who are severely immunocompromised, the recommended duration for work exclusion was extended to 20 days after symptom onset (or for asymptomatic severely immunocompromised HCP, 20 days after their initial positive COVID-19 diagnostic test).
  
• Other symptom-based criteria were modified as follows:
  - Changed from "at least 72 hours" to "at least 24 hours" have passed since last fever without the use of fever-reducing medications.
  - Changed from "improvement in respiratory symptoms" to "improvement in symptoms" to address expanding list of symptoms associated with COVID-19
• HCP with mild to moderate illness who are not severely immunocompromised:
  - At least 10 days have passed since symptoms first appeared and
  - At least 24 hours have passed since last fever without the use of fever-reducing medications and
  - Symptoms (e.g., cough, shortness of breath) have improved
  

Survey Activity Expanded and Increasing

The Department of Licensing & Regulatory Affairs (LARA) shared they have begun to expand nursing facility survey activity, based on guidance from the Centers for Medicare & Medicaid Services (CMS).  LARA survey now includes: 

• Complaints and Facility Reported Incidents (FRI) that are categorized as non-IJ/High priority or P2 status
• Revisit surveys
• Special Focus Facility (SFF) required recertification surveys
• Annual recertification surveys for facilities who have beyond 15 months since their last annual
  

If you have delayed submitting a Plan of Correction (POC) for a survey that was held during the CMS Survey Suspension period, it would be to your benefit to ensure your POC is completed and submitted soon.  As the survey teams begin to work to clear the backlog of pending revisits they will focus on those facilities with an existing, approved POC, leaving those facilities who have not submitted at a lower priority.  This may have a significant impact on enforcement windows and result in extended enforcement actions.

In addition, LARA has begun to incorporate the next iteration of COVID-19 Focused Infection Control Survey (IC) activity as identified in QSO-20-31-ALL.

These surveys focus on facilities with previous COVID-19 outbreaks as defined as:

• Cumulative confirmed cases/bed capacity at 10% or greater; or
• Cumulative confirmed plus suspected cases/bed capacity at 20% or greater; or
• Ten or more deaths reported due to COVID-19
  

State Nursing Facility License Renewals Are Due

Michigan nursing facilities licenses are due to expire on July 31, 2020.  If you have not already submitted your renewal, it's not too late!  You will need the facility license number and complete the process online.  Below are basic instructions for completing the online renewal process:

1. Go to www.michigan.gov/elicense
   
2. Scroll down to bottom of the page and select Renew a Health Facility License.
3. Enter the license number in the Permanent ID field and select the Login button by clicking on it.  Note:  Pushing the return button on the keyboard will not work for this step.
4. Select Pay For License on the menu on the left side.
5. Select Continue in the upper left corner of the box containing the license information.
6. Follow the prompts to provide electronic payment information for the license renewal fee.     
7. Print the receipt for the payment, this is the only opportunity to print a receipt for the payment.

MDHHS Responds to Rapid Testing Questions

Earlier, the Trump Administration announced the US Department of Health & Human Services (HHS) would embark on a one-time procurement of rapid point-of-care testing devices and tests to be distributed to nursing facilities across the country that meet select criteria.  Each nursing facility meeting the distribution criteria will receive one diagnostic instrument - either the Quidel Sofia 2 Instrument or the BD Veritor Plus system - along with the associated tests. There has been some confusion over these testing units, so the Michigan Department of Health & Human Services (MDHHS) staff would like to affirm that these instruments perform antigen tests, which are allowable under MDHHS guidance. As with all tests, clinical presentation remains important and should be considered for decisions as to whether follow up testing is needed.

 

Last week, MDHHS also received questions regarding use of the Abbott Rapid Test.  The questions were shared with the state Public Health and Lab experts for discussion. At this time, MDHHS does not anticipate changing guidance or its position to allow use of the Abbott Rapid Test in nursing facilities. The research on this particular test continues to show rates of false negatives that are of significant concern in a congregate care setting. Additionally, ID Now kits cannot be purchased from the manufacturer directly, even by the state. While the state receives an allotment of cartridges from federal partners on a weekly basis, the supply available to MDHHS is insufficient to support the deployment to nursing facilities in the state, even if the state felt this instrument was appropriate for facility-wide testing in these settings. 

 

AHCA/NCAL Announces Launch of Save Our Seniors

This week, AHCA/NCAL is pleased to announce the launch of a new website to support advocacy efforts related to COVID-19 - www.saveourseniors.org.  As Congress begins debate on the next and possibly, final stimulus package for the year, it is critical that our nation's policymakers understand the importance of prioritizing our vulnerable seniors and individuals with disabilities in long term care.

 

The website outlines the AHCA/NCAL policy priorities for Capitol Hill and the Administration, that long term care providers can acquire the necessary resources to fight the coronavirus and protect their residents and staff.

Browse through the website's interactive timeline to explore how AHCA/NCAL was sounding the alarm since the early days of the pandemic and still to this day. And find related news and updates, including how members of Congress are bringing our issues to the forefront.

 

Visitors to the website can sign up for ongoing alerts from AHCA/NCAL. AHCA/NCAL will be promoting this new website on its social media channels, so be sure to follow AHCA/NCAL on Facebook and Twitter, and help spread the word! 

 

For questions or concerns please contact Cathy Sunlin at CathySunlin@HCAM.org.

July 22, 2020