As a reminder, our COVID-19 Resources webpage includes links to all of our member updates sent from April Payne. Here are quick links to key updates from this week.

• CDC Updates COVID-19 Symptoms
• Preparing for Widespread Testing
• Continuing Restrictions on Visitors in LTC 
• Documentation and Asking for Help
• Updated Accelerated and Advance Payments FAQs

CDC Updates COVID-19 Symptoms

The CDC has updated the list of COVID-19 symptoms. The symptoms now include cough and shortness of breath or difficulty breathing or at least two of the following symptoms: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, vomiting, diarrhea, and new loss of taste or smell.

With the addition of these symptoms, AHCA/NCAL has updated the relevant resources, including the  screening checklist for essential personnel and visitors, as well as the sample daily log for personnel. If you created your own screening tools, you should update to include the additional symptoms. 

Preparing for Widespread Testing

CMS has recently emphasized the importance of testing for COVID-19 in nursing facilities. In addition, a growing number of states are requiring testing of all residents and/or staff. When accessing testing, we recommend providers ensure that the tests are FDA approved PCR tests (versus Antibody/Serology tests) and that the lab will bill Medicare directly. Providers need to have a plan in place to isolate residents who test positive and follow CDC guidance for staff that test positive. AHCA/NCAL has also published this Preparing for Widespread Testing in Long Term Care document.

Continuing Restrictions on Visitors in LTC 

Even as states are beginning to lift their stay at home orders, nursing homes must continue to maintain current restrictions on visitors. As a reminder, CMS released guidance on March 13 that required all nursing homes to significantly restrict visitors and nonessential personnel, as well as restrict communal activities. The guidance indicates that individuals other than essential health care staff and visits for end-of-life situations, should no longer enter nursing homes until further notice.

Even though certain states may be lifting their individual stay-at-home orders, Virginia’s stay-at-home order is in effect until June 10 (unless amended or rescinded.) Nursing homes must continue to follow this directive from CMS until new guidance is received. For help communicating these policies, please see our sample letter to families on restricting visitors.

Assisted living communities must follow DSS guidance, which in this FAQs references CMS and AHCA/NCAL guidance.

For all long term care communities, these restrictions remain critical safeguards to help protect against the spread of COVID-19.

Documentation and Asking for Help

Law firm Husch Blackwell lays out some general steps for documenting activities and response efforts to be prepared for surveys and potential litigation. AHCA/NCAL also recommends working with your legal counsel to develop practices. This resource is available to AHCA/NCAL members (login required).

As a reminder, the association has developed brief guidance for facilities facing personal protective equipment and staffing shortages, as well as other challenges in receiving assistance. Most long term care providers do not have access to the adequate supplies or staff to provide the level of care needed to contain the virus. Documenting requests for assistance is a critical part of managing of the long term consequences of the lack of supplies and testing – and preparing for future surveys.

Unfortunately, also due to this crisis, many long term care providers are unable to fulfill requests for help made to regular contacts (e.g., suppliers, morgues, staffing agencies, etc.) and through traditional communication channels. Long term care providers need to regularly call for help and need to document these calls were made. Continue to reach out to these entities:

• Contact the local and state health departments 
• Contact the state survey agency 
• Consider contacting local government officials such as the mayor, state representative or state senator

Be sure to check out the AHCA/NCAL guidance, which also has information on how to properly document calls for help and the importance of requesting a facility level waiver.

Updated Accelerated and Advance Payments FAQs 

The AHCA Medicare Accelerated and Advance Payment FAQs have been updated to reflect the April 26 CMS announcement that it is reevaluating the amounts that will be paid under its Accelerated Payment Program to Part A facility-based providers (including SNF) and suspending its Advance Payment Program to Part B suppliers effective immediately. 

Specifically impacting SNFs, beginning on April 26, 2020 CMS will be reevaluating all pending and new applications for Accelerated Payments submitted by SNFs and other facility-based providers in light of the $175 billion recently appropriated for health care provider relief payments. Significant additional funding will continue to be available to healthcare providers through these other programs.