ADHCC Update - October 21, 2022
Good afternoon ADHCC members,
Please see the following items of importance:
DOH has posted ADHC Medicaid rates: Attached above is the rate sheet and Dear Administrator Letter for the new rates. The January 2022 rates include the restoration of the 1.5% cut made back in 2020 and the April 2022 rates include the addition of last year's (meager) increase of 1%. It also includes a 5% cut in capital enacted back in 2020 which is based on NH cost reports from 2019. LeadingAge New York's data financial colleague states that basing the capital cut on 2019 utilization rates rather than 2020 utilization rates allows ADHC programs to fair much better. Please let me know if you have any questions about these rates. ADHC rates are published on the web here - https://www.health.ny.gov/facilities/long_term_care/reimbursement/adhc/
MLTC Complaint Hotline and Email - For ADHC programs concerned about MLTC practices, lack of referrals, changes in authorization please contact: 1-866-712-7197 or mltctac@health.ny.gov. Our regional meetings this week yielded ongoing concerns with MLTCs and their practices to move ADHC registrants to social adult day. Please feel free to utilize these numbers to report this activity and access the Fair Hearing process. Some resources on Fair Hearing are here - http://www.wnylc.com/health/entry/184/#V%20Fair%20Hearing
Complaints about Medicaid Transportation: For those having transportation vendor issues, please cc me on your emails. We will be trying to come up with a more formal approach to tracking transportation challenges and mishaps. In the meantime, contact the Department of Health by e-mail at medtrans@health.ny.gov or by phone at (518) 473-2160. Please copy meverett@leadingageny.org on all emails.
New DOH Guidance on Incident Reporting for Nursing Homes: DOH issued updated guidance this week on Incident Reporting. The Dear Administrator Letter can be found here. This also applies to ADHC programs. The process now includes reporting on a web-based portal, not the Health Commerce System. Please review this DAL carefully.
Reportable Incidents include, but are not limited to:
• Abuse, neglect, mistreatment and exploitation
• Misappropriation
• Injury of unknown origin
• Physical environment incidents (ex. fire, loss of services)
• Elopement
• Death not due to natural causes
In addition to an initial facility incident report that must be submitted following reporting timelines (42 CFR 483.12), nursing homes, effective October 24, 20222, must now submit to the Department the results of the facility investigation, called Investigation Summary Report, within 5 days of the incident occurrence. The facility should include any updates to information provided in the initial report and the following additional information, including, but are not limited to, the following:
1. Additional/Updated information related to the reported incident
2. Steps taken to investigate the allegation
3. A conclusion
4. Corrective action(s) taken
5. The name of the facility investigator
A recording of the DOH webinar on the new requirements is here - https://meetny-events.webex.com/webappng/sites/meetny-events/recording/095800dd31f1103b9ffd12b116689b14/playback
New DOH COVID-19 Guidance
Reiterating from last week - you may be aware that CDC and CMS issued updated COVID-19 guidance for nursing homes and health care providers two weeks ago that provided more flexibility for health care providers. Last week DOH issued their new guidance.
The new nursing home guidance is here. Please read it in its entirety.
DOH aligned with CMS and eliminated the requirement that nursing homes (and ADHC programs) routinely test asymptomatic staff who are not “up-to-date” with their COVID vaccinations. However, facilities and ADHC programs may conduct routine testing if they choose. (For example, although this is not specified in the DOH guidance, a facility might choose routine testing as an additional precaution for staff who are exempt from vaccination.)
Masking: All personnel in health care settings (identified as facilities or entities licensed under PHL Articles 28, 36, or 40) must continue to wear an appropriate face mask. Our July 2021 ADHC Reopening Guidance states that all individuals who are fully vaccinated may unmask as long as they are not in a group setting with unvaccinated individuals. However, it also states that "all staff must wear a mask during operating hours;" We urge all ADHC personnel to continue to mask according to the above guidance and this recently issued DOH Advisory.
Symptom Screening: Active symptom screening remains in effect for personnel and visitors in nursing homes. It also remains in place for registrants of ADHC programs. The new CDC guidance (which DOH did not adopt) allows for passive screening for personnel and visitors. We are advocating for passive screening for ADHC staff and registrants.
Testing:
- NYS is aligning with CMS QSO 20-38-NH revised and no longer recommends routine screening testing of asymptomatic staff that are not up to date with the latest booster.
- Staff should be instructed to report to the appropriate facility contact any positive COVID test, symptoms of COVID, or a higher-risk exposure to COVID.
- Nursing homes should follow the testing protocols set forth in Table 1 of CMS QSO 20-38-NH revised. ADHC programs usually follow their sponsoring facility's testing protocols.
- Testing is still required for staff and residents with symptoms, staff with higher-risk exposures, and registrants who are close contacts with a confirmed case, and in outbreaks.
- Outbreak testing should proceed as described in CMS QSO 20-38-NH revised.
- Testing is not necessary for asymptomatic individuals within 30 days of recovery from COVID. For those who have recovered within 31 to 90 days, testing should be considered, and if testing is conducted, an antigen test should be used.
Visitation: Facilities shall not restrict visitation without a reasonable clinical or safety cause. All temporary visitation pauses will occur only under the express direction of DOH.
Return to Work: The guidance did not address the change in the CDC guidance regarding work restrictions for staff who are exposed to COVID.
Isolation and Quarantine: ADHC programs have been inquiring about isolation and quarantine guidance for registrants exposed or infected. This is the current guidance - https://coronavirus.health.ny.gov/system/files/documents/2022/06/quarantine-and-isolation-guidance_05.31.22.pdf
Under the May guidance, regardless of vaccination status, an exposed individual must isolate at home for 5 days, then must mask until Day 10. The guidance says that individuals should not travel, eat with others, congregate with others who may be at risk, so I think it is safe to say that ADHC registrants should not return until after 10 days. No negative test is required to come back to program, but if program prefer this approach, the person should use an antigen test.
The tail end of the guidance mentions congregate settings which ADHC could fall into, though its unclear, and the 10 days is required for those settings as well.
Programs should also note that there is new quarantine and isolation guidance for the general public here. The general public guidance is less restrictive and requires masking for 10 days if exposed.
Health Care Worker Bonus Program: All ADHC Programs are eligible for the Home Care Workforce Bonus program. Some job titles may not be eligible, but most are, if an individual qualifies for the listed vesting periods and falls under the compensation threshold. Please check in with your sponsoring nursing home to confirm that they are making submissions for these bonuses for your ADHC staff. Some nursing homes are under the impression ADHC is not eligible. This is false. Contact me if you have any concerns.
CMS Visits to ADHC Programs re HCBS Rule - Some upstate programs will be visited by CMS and DOH next week for HCBS Settings Rule Compliance. Please let me know if your program has been contacted.
Please feel free to reach out with questions or concerns - Meg Everett, meverett@leadingageny.org, 518 867-8871.