To: Mass Senior Care Members
From: Tara M. Gregorio, President
Re: COVID-19 Updates: DPH Issues Revised Guidance on Public Health Order; DPH Releases Updated Guidance on Caring for LTC Residents during COVID-19 Emergency; MassHealth Issues UPDATED Nursing Facility Bulletin for New Targeted Isolation Space Program; Nursing Home Budget Amendment Included in DPH Report; CMS Updates
Date: November 13, 2020
DPH Issues Revised Guidance on Public Health Order
Today the Department of Public Health (DPH) released revised guidance to long-term care facilities to assist with the implementation of the Public Health Order from Massachusetts Department of Public Health (DPH) Commissioner Monica Bharel issued on November 5. This memorandum replaces guidance previously issued on November 5 and provides updates on how DPH will determine the inadequate staffing factor. To address concerns about inadequate staffing, DPH will consider “inadequate staffing” at a facility to mean there are not enough nursing staff to sufficiently meet the needs of the facility’s residents. Inadequate staffing will be evidenced by one of the following:
- being cited for a staffing related deficiency during a survey;
- fewer than one licensed nurse assigned to care for 30 residents during each shift averaged over each 24 hour period;
- or one nurse aide assigned to care for 15 residents during each shift averaged over each 24 hour period.
Today, the Department of Public Health released updated guidance on Caring for Long-Term Care Residents during the CVID-19 Emergency. This update includes guidance on a resident’s planned leave of absence from the facility. Specifically, the facility clinical leadership should work with the resident and their loved ones to create a plan for a safer leave. This plan must include education for the resident and loved ones about:
- The need for the resident to quarantine for fourteen days upon return from leave
- Wearing cloth face coverings
- Practicing physical distancing
- Limiting interaction to the fewest number of people possible while the resident is on their planned leave
- Loved ones also limiting their interaction to the fewest number of people possible for two weeks before the resident’s planned leave/visit
- Assessment about the possible exposure risks while the resident is on their planned leave and instructions about how to mitigate them.
If the facility does not have a room available for quarantine for a resident who is returning from a planned leave of absence, then loved ones may be required to keep and care for the resident until a room is available. The facility must communicate this to the resident and their loved ones prior to the resident leaving the facility. Long-term care facilities should test any resident returning from a planned leave of absence, however, a negative test result does not remove the requirement to quarantine for the 14 day period.
In addition, the Executive Office of Health and Human Services released a Holiday letter to long term care and congregate care facilities outlining alternative ways to celebrate the holiday and guidelines on visits and travel. We encourage facilities to share this letter with residents, resident’s families and responsible parties. We also encourage facilities to optimize facility visits during the holiday season and to educate staff on the importance of wearing masks, social distancing and hand hygiene during their own holiday activities. Additional information to share with staff regarding holiday gatherings can be found here.
MassHealth Issues UPDATED Nursing Facility Bulletin for New Targeted
Isolation Space Program: MODIFIES PROGRAM ELIGIBILITY CRITERIA
MassHealth today issued Nursing Facility Bulletin 156 which modifies the criteria for participation for the new targeted Isolation Space Program. The original Isolation Space program ended on September 30th. Under the new Isolation Space Program, EOHHS will identify a subset of facilities to ensure regional access to isolation space facilities. Nursing Facility Bulletin 156 supersedes MassHealth Nursing Facility Bulletin 144 and MassHealth Nursing Facility Bulletin 150. The revised criteria include the following changes:
2. The nursing facility has had no infection control deficiencies, identified by DPH through the COVID-19 Focused Survey for Nursing Homes required by CMS, within 60 days before submitting the attestation form attached to this bulletin as Appendix A, and continues to be deficiency free on such infection control surveys while operating an isolation space under this bulletin.
5. The isolation space established by the nursing facility contains the lesser of at least 10 licensed beds for COVID-19 positive residents or 10% of the licensed beds within the facility.
11. The nursing facility will remain in compliance with the November 5, 2020, Order of the Commissioner of Public Health Regarding Control of COVID-19 in Long-Term Care Facilities (“DPH Order”); facilities under a temporary admissions freeze per the DPH Order will not be eligible for the program with the exception of a freeze being implemented for the sole reason of high staff COVID-19 positive cases, described under factor 1 in the DPH Guidance, Implementation of Order of the Commissioner of Public Health Regarding Control of COVID-19 in Long-Term Care Facilities (“DPH Guidance”).
In order for MassHealth to approve a provider as a qualified nursing facility eligible to operate an isolation space, a nursing facility administrator or other appropriate representative must attest to the criteria specified in the Bulletin which is included as Appendix A, and must submit the executed form via email to Christine Kim at email@example.com by 11:59 p.m. on Friday, December 11, 2020. Upon notification from MassHealth that the provider’s attestation has been approved, the provider will be eligible for the supplemental payment under 101 CMR 206.10(3)(d): Calculation of Supplemental Payment as of the date of approval. MassHealth will review attestation submissions in the order they are submitted. Therefore, providers are encouraged to submit attestations earlier than the due date, in order to be approved as a qualifying nursing facility and receive the supplemental payment more quickly.
Nursing Home Budget Amendment Included in House FY 2021 Budget
The House of Representatives earlier this week approved its FY 2021 budget. The House amended budget amendment #31 to require the Department of Public Health to report by Feb. 1, 2021 on rules, regulations, guidance, and best practices to prevent the transmission of COVID-19 from patients discharged from hospital facilities to nursing homes, rehabilitation centers, skilled nursing facilities, and other congregate care facilities. Mass Senior Care extends our gratitude to nursing facility members, staff, and resident family members for their advocacy, which resulted in over 900 messages to their lawmakers. In addition, we thank Chairwoman Ruth Balser (D-Newton) and Chairman Tom Golden, Jr. (D-Lowell) for their work on budget amendments related to quality nursing home care.
The FY 2021 Budget now moves to the Senate for their consideration. Thank you for your continued advocacy, Mass Senior Care will continue to provide members the latest budget updates.
Yesterday, CMS Administrator Seema Verma announced the following updates to stakeholders including AHCA and state affiliates:
- CMS or state surveyors will be calling nursing homes who report new cases of COVID and/or report shortages of PPE and/or staffing to offer assistance. They will ask several questions to see how they can help the facility acquire resources such as staffing, PPE or testing supplies.
CMS will be publishing a list of facilities who have completed the CMS 3 to 4 hour QIO trainings.