Whitmer Extends State of Emergency
Yesterday, Governor Gretchen Whitmer issued Executive Order 2020-177, extending the State of Emergency through October 1, 2020. This action will extend the power to call upon additional resources needed to address the pandemic.
Whitmer wrote, "Statewide coordination of these efforts is crucial to creating a stable path to recovery. Until that recovery is underway, the economic and fiscal harms from this pandemic have been contained, and the threats posed by COVID-19 to life and the public health, safety, and welfare of this state have been neutralized, statewide disaster and emergency conditions will exist."
HHS Approves Funding Allocation for Private Pay Assisted Living - Hard Deadline to Apply
On September 1, 2020 the U.S. Department of Health and Human Services (HHS) announced that private-pay assisted living/memory care providers will be eligible to apply for CARES Act Provider Relief Funds under the current Phase 2 General Distribution round of funding.
Like other providers applying for Phase 2 funding, eligible assisted living communities will receive 2 percent of their 2019 annual revenue from patient care and will have until September 13, 2020 to begin their application. Please visit the Provider Relief Fund webpage and then click on the Providers link to locate specific information on the application process and to begin an application. One of the available resources included under the Apply Now link is a CARES Act Payment Portal User Guide. This guide includes videos and links to information needed to access the portal and for each step of the application process.
A few notes based on questions MCAL has been receiving from Members:
- An FAQ document is being prepared and we will distribute it hopefully early next week.
- The collection of TINs that many of our members responded to several weeks ago does not qualify as application for this distribution. Even if you replied to that survey, you still need to apply for this distribution.
- ALL FACILITIES MUST APPLY BY SEPTEMBER 13. We would suggest getting your application submitted before that date. HHS has been very clear that there will be NO Extension on the September 13 deadline.
- Several weeks ago HHS requested a list of "Assisted Living" Facilities from the Michigan Department of Licensing & Regulatory Affairs (LARA). This list was for the purposes of the possible development of a monetary distribution to Assisted Living communities. The list that was sent from Michigan included Homes for the Aged (HFA), Adult Foster Care and the list of HFA exempted facilities. NCAL has encouraged that all of these facilities should apply for the distribution.
- Independent living is not included in this distribution.
- If you think you may qualify, take the time to apply.
- If you don't apply, you will not receive a distribution. This is not an automatic distribution like the nursing facilities received.
- AGAIN - THE DEADLINE IS SEPTEMBER 13.
MDHHS PPE Grant Update: Application Period Closing and Q&A
The Michigan Department of Health and Human Services (MDHHS) issued guidance and the application process for the $25 million PPE grant program contained in Senate Bill 690 last week. The grant program is available to numerous healthcare providers, including nursing facilities and residential congregate facilities. The program will provide funds to providers to cover costs for up to 90 days of PPE for frontline employees. Grant awards of up to $250,000 will be made based on the number of client-facing workers at each facility.
The application period closes Tuesday, September 8, 2020. Awardees will be notified by September 21.
Under the program, the award amount is set by a formula per patient/client-facing FTE, adjusted for the typical amount and type of PPE needed in that setting. Group 1 facilities receive $1,000 per frontline FTE. Group 2 facilities receive $2,500 per frontline FTE - long-term care facilities are included in Group 2.
PPE must have been purchased on or after March 1, 2020, and delivered before December 30, 2020. Proof of purchase and delivery will be required.
MDHHS has provided a Q&A for several topics to assist providers:
Q: The terms and conditions state that if a provider has received CARES funds for these items already they should not request reimbursement. As you know many of these providers who are eligible for this program have received CARES funds for costs associated with COVID but not specifically for PPE items. We are assuming that just because a provider has received some CARES Funds that does not preclude them from applying for this reimbursement for past costs or future PPE purchases through December 30, 2020. HCAM has estimated even with the current CARES funds nursing facilities have an overall funding gap around $100 million in COVID related costs through December 30, 2020. Is this a correct interpretation of the program?
A: That interpretation is correct. Payments from this award shall not be used to cover expenses that have been billed to insurance and/or patients, or for which the organization has received any other federal funds or emergency COVID-19 supplemental funding (whether state, federal, or private in nature) for the same expense. If the entity has received other federal COVID relief funds (such as PPP) or CARES funds not for the purpose of buying PPE, they may still apply for this grant. There was some confusing language in the Terms and Conditions which we are working on fixing.
Staff Considered Frontline
Q: The program is paid on an FTE basis for frontline staff directly caring for the resident. We are assuming that would include all of these staff categories: nursing (RN, LPN, and Certified Nurse Aide), activities, housekeeping and dietary aides. Is this correct?
A: Yes, those all appear to be appropriate categories of frontline staff caring directly for residents who would need PPE to perform their duties.
Application for Corporations
Q: The application refers to sending one application for a type of provider. Does this mean a nursing facility chain with multiple Michigan facilities can file one application of all of the buildings related to the organization? Or does the nursing facility chain need to file a separate application for each building?
A: A nursing facility chain with multiple facilities can file one application for all buildings related to their organization. We will be considering applicants to be parent organizations at the level of EIN, not buildings.
You can find further details in the FAQ document HERE.
You can apply for a grant on the program webpage by clicking HERE.
Nursing Facility COVID Testing & CMS Positivity Rates
There have been a number of questions regarding how the recently released Centers for Medicare & Medicaid Services (CMS) required COVID testing cadence intersects with the current Michigan Department of Health & Human Services (MDHHS) COVID testing cadence for nursing facilities. Members should be aware that states are offered the opportunity to issue guidance or regulatory language that exceeds the federal requirements, which is the case in Michigan.
Members should be reviewing both federal and state issued language in regards to COVID testing, apply the more stringent requirements in each instance. Outbreak and Screening testing requirements as they apply to Michigan nursing facility providers are outlined below:
Outbreak Testing will require providers to test both staff and residents weekly if a new case is identified in either a staff member or a resident. This weekly testing of all continues until a minimum of 14 days has elapsed since the last positive test.
Screening Testing in counties with a high positivity rating as identified on the CMS COVID-19 Nursing Home Data webpage requires bi-weekly testing. For staff members who only work weekends, this could require testing on consecutive days, Saturday and Sunday, to meet the bi-weekly requirements.
CMS had previously shared they would be updating the County Positivity Rates on the 1st and 3rd Mondays of each month. Given the holiday weekend, CMS posted updated rates mid-week this week. All Michigan counties currently are in either the green or yellow categories, which will require continuation of our current weekly COVID testing cadence.
PASARR Changes Coming
Earlier this year, the Michigan Department of Health & Human Services (MDHHS) notified hospitals across the state of intended changes to the Omnibus Budget Reconciliation Act (OBRA) referral process. These changes were intended to move the Patient Screening and Resident Review (PASARR) process to an electronic method for initiation of a Level I Screen (DCH-3877 and DCH 3878 forms) for persons with a mental health diagnosis or who are receiving mental health treatment requesting admission to a nursing facility.
MDHHS has shared they intend to launch the changes this Fall; however, a firm date has not been released as of yet. Once the electronic system goes live, the process will require mandatory compliance for all hospitals, nursing facilities, and other referral sources. MDHHS is expecting to provide a web-based training for all users later this month. As dates and more information become available, we will share with members.
For questions or concerns please contact Cathy Sunlin at CathySunlin@HCAM.org.
The association team wishes everyone a safe & happy holiday!
Mask Up - Stay Safe
Sept. 4, 2020