Governor Whitmer Signs FY 2020-2021 State Budget
Governor Whitmer signed the budget yesterday for the fiscal year beginning today October 1, 2020. You may find the budget bill by clicking HERE.
Fortunately, the budget did not reflect a cut to Medicaid that was originally included in the Governor's recommendation. Included in the budget are a number of provisions impacting the profession:
Continuation of $2/Hour Wage Pass Through for Direct Care Workers
The budget includes CARES Act funding to continue the $2 per hour wage pass through for direct care workers for an additional three months through December. It is our understanding that this is a continuation of the current program and will apply to the same direct care workers (RN, LPN, CNA, and respiratory therapists). We have requested further details on this funding from the Department of Health and Human Services (MDHHS), which indicated they will be releasing guidance in the coming days.
$20 Million PPE Grant for Skilled Nursing Facilities
HCAM has been advocating for funding from the state to support nursing facilities COVID-19 response. In response, the budget includes $20 million in Personal Protective Equipment (PPE) grants specifically for nursing facilities. The funding will be distributed to facilities based on licensed beds. HCAM is advocating for greater flexibility for the use of these funds, including for staffing, business interruptions, and other expenses related to COVID-19. We will provide further details on the grant once they are received from MDHHS.
Updated CAV Limit
The budget bill also included boilerplate language increasing the capital asset value bed limit (CAV). This language was previously negotiated between HCAM and the state budget office in previous years. The current CAV limit is based on a database of construction costs dating back to 1975. The new limit will be determined based on a rolling 15-year history of new construction, and the increase in the current asset value bed limit shall not exceed 4 percent of the limit for subsequent fiscal years. This will allow for more accurate reflection of construction costs. HCAM is seeking clarity from MDHHS on how this will impact the CAV limit for the current fiscal year - the department is still in the process of determining the limit.
Changes to AL Setting COVID-19 Reporting Requirements
Yesterday, September 30, 2020 the Michigan Department of Health & Human Services (MDHHS) sent an email to all assisted living setting providers registered and reporting in the Michigan LTCF COVID-19 Reporting system via Survey Gizmo. This email identified that Effective immediately, MDHHS is no longer requiring Assisted Living facilities to report COVID-19 data directly via the Survey Gizmo platform as outlined in the letter issued on May 22, 2020.
MDHHS has shared with the Association they expect to issue updated guidance and requirements for COVID-19 reporting specific to Homes for the Aged (HFA) and Adult Foster Care (AFC) settings in the coming weeks.
While Assisted Living facilities are no longer required to report COVID-19 data directly to MDHHS, this does not remove the requirement for these facilities to contact the local health department in the facility's jurisdiction to report the presence of a confirmed COVID-19 positive employee or resident.
If you have any questions about the change in reporting requirements, you may direct them to MDHHS-MSA-COVID19@michigan.gov.
Assisted Living Setting Communal Dining & Activities
MCAL has received many questions regarding communal dining and activities with the release of Executive Order 2020-191. EO 2020-191 extends most of the prior provisions included in Executive Order 2020-179 along with identifying new and updated guidance. The EO is effective immediately and is in effect until rescinded.
The Order shares that communal dining and activities may be conducted following the Centers for Medicare & Medicaid Services (CMS) and Michigan Department of Health & Human Services (MDHHS) guidance.
Assisted living (AL) setting providers should note the CMS guidance regarding communal dining and activities is NOT applicable to AL settings. ALs should utilize CDC guidance published for congregate care settings and assisted living settings. This guidance provides an excellent resource for infection control practices and controls within the AL settings.
Upgrade SAMS Access to Utilize New Point of Care Laboratory Reporting Pathway in NHSN
The Centers for Disease Control & Prevention (CDC) National Healthcare Safety Network (NHSN) will release a new Point of Care (POC) Laboratory Reporting Pathway within the NHSN LTC COVID-19 Module on October 15, 2020. The new Pathway will enable CMS-certified nursing homes an avenue to meet the Department of Health and Human Services' requirement to report SARS-CoV-2 point-of-care antigen test data, and other on-site COVID-19 laboratory testing data, to appropriate federal and state health authorities. Using the pathway will require an upgraded NHSN Secure Access Management Service (SAMS) from Level 1 to Level 3. Please be on the lookout for an email invitation from CDC to perform this upgrade.
This new NHSN Pathway will provide a single reporting system that nursing homes already use for other mandatory COVID reporting and will meet the requirement to report SARS-CoV-2 point-of-care antigen testing data to state health departments and other appropriate federal authorities. Currently, the Michigan Department of Health & Human Services (MDHHS) requires reporting of positive results within 4 hours to the local health department via phone, fax or electronically through the Michigan Disease Surveillance System (MDSS). We are working to clarify how the NHSN reporting will intersect with the MDHHS reporting and will share as the information is available.
Facilities interested in advancing to Level 3 access can email email@example.com with the subject line "Enhancing Data Security" to begin upgrading their SAMS access to use the new Pathway.
Confidential Dry Run Reports for the Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations Measure are now Available
The Centers for Medicare & Medicaid Services (CMS) announces the Confidential Dry Run Reports containing FY 2018 and FY 2019 performance scores for the Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalizations measure (SNF HAI measure) are now available. Performance scores are based on the draft measure specifications posted on CMS Measure Management Public Comment page. Providers can view these reports in their Certification and Survey Provider Enhanced Reports (CASPER) provider shared folders. These reports are accompanied by a Data Dictionary defining key measure terms.
The purpose of these Confidential Dry Run Reports is to allow skilled nursing facilities (SNFs) to become familiar with this measure and to inform them of their performance in comparison to their peers. It is important to recognize that HAIs in SNFs are not considered "never-events." The goal of this risk-adjusted measure is to identify SNFs that have notably higher rates of HAIs and to statistically distinguish between SNFs that are either better than or worse than their peers in infection prevention and in infection management. SNFs may choose to incorporate this measure into their internal quality assurance activities to improve patient outcomes. Note that review and use of this measure information is strictly voluntary.
FRIDAY, OCT. 2: AHCA/NCAL Office Hours on Provider Relief Fund Reporting Requirements
On Friday, October 2 at 3:00 pm EST, AHCA/NCAL will host an "office hour" to provide up-to-date answers to your questions about provider relief fund reporting requirements based upon available information and interpretation. To date, HHS only has released six pages of guidance and we await a reporting template, the US Department of Health & Human Services (HHS) case examples, and webinar trainings. HHS continues to update these requirements, resulting in confusion about what is expected of providers. Mike Cheek, SVP of Reimbursement Policy, will provide an updated overview of the requirements and answer your questions. Please note, further updates and revisions to the requirements are expected to continue to be made.
No pre-registration is required but you will need to login using your computer or WebEx application as all questions will be accepted using the chat function. All lines will be muted.
Provider Relief Fund Reporting Requirements Office Hours
Friday, Oct 2, 2020 3:00 pm | 1 hour | EST
Meeting number: 172 413 7902
Join by video here
MDHHS Support of COVID Testing for HFAs
MCAL Members: We know that the cost of testing is a factor in your facilities' decision to test or not test. Please read carefully this opportunity for support and recommendations. MCAL has requested support for all other AL settings also but information shared with us indicates that the state is overwhelmed by the number of AL settings in Michigan. They are currently looking at how they may begin to include AFC's (starting with large) in the program - but no promises yet. We will keep you up to date on any movement on your behalf. But for now - HFA's please take advantage of the following:
Michigan Offers Assistance and Reimbursement to Promote More COVID-19 Testing in Homes for the Aged
The Michigan Department of Health and Human Services (MDHHS) urges Homes for the Aged (HFA) to conduct regular testing for COVID-19, and announced today an expansion of state assistance and reimbursement to support more testing in these facilities.
HFAs provide room, board and supervised personal care to 21 or more individuals ages 55 or older. Due to the significant risk of outbreaks in long-term care facilities and the higher likelihood of severe health outcomes caused by COVID-19 among the elderly, it is imperative that HFAs provide routine testing to identify infections quickly and contain spread. As of Sept. 10, 45 ongoing outbreaks and four new outbreaks had been reported at long-term care facilities across Michigan, including nursing homes, HFAs, assisted living and adult day care.
"COVID-19 presents acute risks to older adults, especially in congregate care settings. Robust testing is vital to protect these facilities, and the residents and staff from outbreaks," said Robert Gordon, director of MDHHS. "We encourage all Homes for the Aged to start testing programs to protect residents as quickly as possible if they haven't already; the state stands ready to help with testing resources and funding."
MDHHS recommends HFAs in regions of risk levels A through E on the MI Safe Start Map, test all residents and staff:
- One-time baseline testing of all residents and staff.
- Weekly testing, until all staff and residents are negative for 14 days since the last positive test.
- At the time of admission for new residents.
- Before new staff members start work.
- When having COVID symptoms.
- After close contact with a COVID-positive individual (within six feet for fifteen minutes or more).
To help implement these recommendations and encourage more testing in HFAs, MDHHS is providing expanded testing assistance and reimbursement.
HFAs that conduct COVID-19 testing for residents or staff will be eligible for reimbursement of laboratory costs not covered by insurance or by other types of state assistance. MDHHS Financial Guidance for HFA Testing provides more details on this process.
Facilities can alternatively seek state assistance to conduct testing. The state can provide medical staff, supplies, and/or laboratory processing, depending on the needs of the facility. HFAs with a medical provider who can order a test should complete the state's testing request template and submit it to MDHHS at MDHHS-LTCRequests@michigan.gov. HFAs without a medical provider to order the test should contact their local health department to request testing assistance.
For questions or concerns please contact Linda Lawther at LindaLawther@michcal.com.
FY 2021 Final Rule: CMS-1735-F - Submitting Documents for NOMNCs
Federal regulations under FY 2021 Final Rule: CMS-1735-F now require ALL providers to transmit medical records and other documentation (like the Notices of Non-Coverage) to the Beneficiary and Family Centered Care - Quality Improvement Organizations (BFCC-QIOs) electronically using an electronic submission method determined by the QIO. Providers will now be reimbursed a flat rate of $3 per case for the electronic submission.
Beginning October 1, 2020, Livanta will accept medical records electronically in two ways. Providers may choose which method is best for them and submit medical records accordingly.
- Direct Secure Messaging. Direct Secure Messaging can be performed through many electronic medical record (EMR) systems. To clarify, Direct Secure Messaging is NOT email. Your organization must obtain Direct Secure Messaging credentials that support accredited Health Information Service Provider (HISP) protocols. If necessary, please consult with your organization's IT department or EMR vendor to determine how to comply with the Final Rule and securely transmit medical records from your EMR to Livanta upon request.
Where to Submit Medical Records: Medical records may be transmitted to Livanta through Direct Secure Messaging at the following addresses:
For discharge appeals and service termination appeals:
QIOAppeals @ Direct.Livanta.com
For quality of care complaints:
QIOQuality @ Direct.Livanta.com
- Livanta File Transfer Portal. Providers can access a portal application via www.LivantaQIO.com by clicking on the e-LiFT portal button (as shown below) to directly upload medical records as a .PDF file. To ensure secure transmission, providers must enter the Case Control ID and the unique EMR Key supplied on the attached Medical Record Request before uploading any medical documentation.
Per the Final Rule, beginning October 1, 2020, providers without an EMR MUST obtain a waiver from the Livanta BFCC-QIO to continue faxing medical records. Waivers may be applied for directly through Livanta's webpage at: https://LivantaQIO.com/en/Provider/Waiver.
Livanta will continue to accept medical records from all sources while providers transition. However, after October 1, 2020, payments for faxed and hard copy medical records will not be processed for providers that do not already have an approved waiver.
For additional information, including Frequently Asked Questions, please visit our website at https://LivantaQIO.com/en/Provider/Medical_Records.
For waiver information, please go to https://LivantaQIO.com/en/Provider/Waiver.
For questions or concerns please contact Cathy Sunlin at CathySunlin@HCM.org.
October 1, 2020