Coronavirus Daily Update: Cash Flow Relief Coming; Congress Hints at More Action

During this critical time, Home Health Care News remains committed to bringing you all the essential news related to home-based care operations. At the same time, we also recognize the seriousness of the COVID-19 pandemic. In addition to our regular content, we’ll continue to highlight industry-related developments and mitigation strategies in this rolling bulletin.

What you need to know from Friday through Sunday (March 27-29)

— To reduce cash flow disruptions, CMS announced Saturday it is expanding its accelerated payments program for Medicare health care providers.

— CMS has approved another group of Medicaid 1135 waivers, bringing the total to 34 states; the new batch includes Wyoming, Minnesota, Delaware, Connecticut and Pennsylvania.

— In part to avoid visit cancellations, LHC Group and other home health providers are visibly promoting pre-screening procedures for all clinicians prior to entering a patient’s home.

— The United States now has more confirmed COVID-19 cases than any other country, according to a Johns Hopkins database; the global count has surpassed 670,000 cases.

— As home health workers and others on the frontline of the COVID-19 crisis continue scrounging for PPE supplies, some members of Congress have hinted at yet another relief measure.

Congress considering another relief package

On Friday, Congress and the White House finalized a $2 trillion COVID-19 relief package, which included new flexibility for home health providers in the form of non-physician certification. The package — officially titled the CARES Act — was the third major piece of legislation enacted in recent weeks.

Now, lawmakers are hinting that a fourth may be on its way.

“We have to pass another bill that goes to meeting the need more substantially than we have,” House Speaker Nancy Pelosi told CNN on Sunday.

Specifically, Pelosi cited more legislation is needed to increase protections for workers on the front lines, among other priorities.

“We have other issues that we have to deal with in the bill in terms of personal protective equipment and OSHA rules that protect workers,” Pelosi told CNN. “We have to do more on family medical leave. We have to be able to make people who get tested also have their visit to the doctor covered.”

What you need to know from Thursday (March 26)

— CMS approved six additional 1135 waivers on Thursday for Medicaid providers in New York, Massachusetts, Idaho, Hawaii, Colorado and Maryland; the agency has now approved 29 overall.

— Amedisys (Nasdaq: AMED) CEO Paul Kusserow told USA Today that the company is seeing significant visit cancellations from patients worried about in-home clinicians carrying COVID-19.

— Humana Inc. (NYSE: HUM) announced it is taking several measures preparing for the influx of patients who will need to be treated for coronavirus.

— In-home care officials once again warned of a possible industry collapse.

— HHCN highlighted more home health care-related provisions within lawmakers’ $2 trillion relief package.

What you need to know from Wednesday (March 25)

— CMS approved several new 1135 waivers on Wednesday to give providers added flexibility in: Iowa, Indiana, Rhode Island, Kansas, Kentucky, Missouri, Oregon, North Dakota, South Dakota and Oklahoma.

— Sources told HHCN that $2 trillion stimulus package in the works includes multiple provisions directly related to home health care.

— U.S. medical officials see signs of coronavirus becoming cyclical, perhaps changing how home health providers view the virus on a long-term basis.

What you need to know from Tuesday (March 24)

CMS announced late Monday that it has approved 11 additional Medicaid 1135 waivers, giving providers relief on prior authorization and certain enrollment requirements.

— Richard Fiesta, executive director at the Alliance for Retired Americans, urged members of Congress to back recently introduced legislation designed to support older Americans’ ability to age in place amid the ongoing coronavirus pandemic.

— Healthpeak Properties (NYSE: PEAK) says seven senior housing communities in its portfolio have confirmed COVID-19 cases.

— Without additional support, a majority of hospitals within the next 60 days will have little choice but to engage in massive layoffs of non-clinical staff to stay afloat financially, according to an analysis by Strata Decision Technology.

— As of 5:30 p.m. CT, federal lawmakers and the Trump administration continued to work on a deal to pass an estimated $2 trillion stimulus package with far-reaching implications; a Senate version of the package, for reference, included language to encourage the use of telehealth technology within home health care.

CMS approves 1135 waivers

CMS has approved an additional 11 state Medicaid waiver requests under Section 1135 of the Social Security Act, bringing the total number of approved Section 1135 waivers to 13.

The newly issued waivers are for the following states: Alabama, Arizona, California, Illinois, Louisiana, Mississippi, New Hampshire, New Jersey, New Mexico, North Carolina and Virginia. Washington and Florida previously received 1135 waivers last week.

“These waivers give a broad range of states the regulatory relief and support they need to more quickly and effectively care for their most vulnerable citizens,” CMS Administrator Seema Verma said in a statement.

Examples of the waivers include the temporary suspension of prior authorization requirements and extending existing authorizations for services through the end of the COVID-19 public health emergency. CMS is also relaxing restrictions on states working with out-of-state providers under Medicaid.

What you need to know from Monday (March 23):

CMS announced Monday that it will not authorize standard surveys for home health agencies, nursing homes and other care sites; the suspended surveys also include life safety code and emergency preparedness inspections, as well as any revisits not associated with an immediate jeopardy claim.

— Also on Monday, CMS announced preliminary results of a recent inspection of the Life Care Center nursing home in Kirkland, Washington, which is the epicenter of the COVID-19 outbreak in that state.

— Despite concerns with COVID-19, the majority of senior housing properties continue to maintain their occupancy rates, according to new data from the National Investment Center for Seniors Housing & Care (NIC).

— In a White House briefing Sunday night, Vice President Mike Pence urged all labs developing coronavirus testing kits to prioritize in-patient testing.

— As of Monday, doctors, nurses and ambulance drivers reportedly made up about 12% of Spain’s nearly 33,000 coronavirus cases, a statistic that underscores just how dangerous the virus is for frontline health care workers who don’t have proper personal protective equipment (PPE).

— As of 5 p.m. CT Monday, the Senate had once again failed to move forward with another major economic stimulus package, one that would also have implications for the health care sector.

CMS sheds light on surveys

CMS is further shifting its oversight and enforcement activities to specifically focus on infection control and prevention.

“The plain fact is that, with Coronavirus spreading and personal protective equipment at a premium, some of our state inspectors can be pulled away by their governors to help with other aspects of the Coronavirus response,” CMS Administrator Seema Verma said during a Monday press conference.

Moving forward, standard surveys for home health agencies will not be authorized.

Additionally, the imposition of suspension of payments (SPNA) for new admissions following the last day of the survey when termination is imposed will be lifted to allow for new admissions during this time.

CMS is also suspending per day civil money penalty accumulation, in addition to the imposition of termination for facilities that are not in substantial compliance at six months.

Residents not moving out of senior housing

Early on in COVID-19’s spread throughout the U.S., some speculated more older adults would turn to in-home care over senior housing communities. A new survey commissioned by NIC suggests that trend isn’t happening.

About 79% of senior housing operators saw no significant changes in move-outs last week and no significant changes in occupancy, according to the survey, which included private-pay senior housing operators representing 1,078 buildings and 100,899 units.

Still, several U.S. operators noted that sales and marketing activities including all move-ins have been halted completely due to the COVID-19 pandemic. Other operators continued to allow pre-scheduled move-ins to occur, though with extra steps and screening.

For daily updates from the week of March 16, click here.

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