FEMA REQUEST FOR PUBLIC ASSISTANCE (RPA) – DD-4480 (COVID-19)
TOPIC #1: Setting Up a FEMA Grants Portal Account
DD-4480 was declared for only Category B – Emergency Protective Measures.
Emergency Declaration date: March 20, 2020
Incident date: January 20, 2020*
*Reimbursement can be sought for activities starting on January 20, 2020
All private, non-profit (PNP) applicants must be deemed “critical” or “essential/non-critical”:
Some PNP entities may already have a Grants Portal Account:
If YES, there will be a box in the upper part of the screen that states that “Your Parent Organization has been assigned as the primary Grantee for one or more disasters and you may submit a Request Public Assistance (RPA) to FEMA’s Public Assistance program”. You should click as directed and follow the instructions as prompted.
If NO, DHSES will create one upon receipt of the following required information, along with the completed, attached RPA package:
o Applicant Name
o Type of Applicant**
o Federal Employer ID Number
o Primary Office Location
o Street Address
o City
o State
o ZIP Code
o County
o Primary Contact
o First Name
o Last Name
o Title
o Phone Number
o Email
** Includes: State Government, County Government, City, Town, Village or Special District Government, Public/State Controlled Institution of Higher Education, Regional Government Organization, Independent School District, Public/Indian Housing Authority, Federally Recognized Native American Tribal Nation Government or Designate Organization, Non-profit with 501(c)(3) status, Non-profit without 501(c)(3) status, or other.
We suggest that applicants include the information requested above in the body of an email, along with the completed RPA forms as an attachment. Normally, the RPA documentation must be submitted within 30 days of a declaration, but that has been waived and there is currently open enrollment. The email should be sent to Patricia Debboli at: patricia.debboli@dhses.ny.gov.
The Grants Portal is a web-based application used for managing FEMA Public Assistance projects. Once an account is created, you will receive an email with a temporary password and an invitation to log in and create a new password (the email will be from support@pagrants.fema.gov).
DataPoint: Nursing Home Deficiency Update
Of the 450 homes surveyed statewide through February 2019 under the new survey process, 12.2 percent were deficiency-free. The top 10 most frequently cited deficiencies represented 44.8 percent of all deficiencies. Fifteen percent of all nursing home deficiencies were represented by the top two most commonly cited deficiencies, F-880 (Provide and implement an infection prevention and control program) and F-656 (Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured), each accounting for more than 7 percent of all deficiencies statewide. The most deficiencies under the new survey process occurred in the Rochester region, while the Northeastern region had the distinction of having the highest average number of deficiencies per home and the highest average number of deficiencies per 100 beds. Deficiency-free surveys occurred in less than 2 percent of homes surveyed in both the Rochester and Buffalo regions.
To view nursing home deficiency counts by region and the top 10 most frequently cited deficiencies statewide, click here.
Benchmarking can help ASCs evaluate financial performance and identify areas to improve, according to ASC revenue cycle service company Serbin Medical Billing.
Three revenue cycle benchmarks to track:
1. Compiling external benchmarking data from other ASCs can give revenue cycle staff an idea of how their ASC is performing compared to others.
2. Gathering data on your own ASC through internal benchmarking is also useful. The key data to collect includes average reimbursement, average days to bill and overhead costs.
3. Internal benchmarking can also help when determining areas for quality improvement.
Did you know that most doctors have no idea of just how many of their claims get rejected each week? If they did, they might fire someone. A whopping 30 to 35% of all paper claims are rejected or denied by insurance carriers due to error.
Claims are denied for various reasons but most frequently, for lack of information, or incorrect information. The facts say that fewer than 2% to 3% of insured’s who experience a denied claim even bother to exercise their appeal rights, mainly because the insured is required to request a review in writing, which takes time and understanding, which many people don't have. Most people never read their own insurance policy, let alone understand it. Imagine if every insurance carrier denied every 10th claim, period. The carriers would stand to gain millions of dollars just by playing the odds. I'll give you an example: If a carrier denied 100 claims that totaled $1,000 and only 2% to 3% of the claims were paid after appeal, the insurance carrier would gain more than $950 just by denying the claims. With Claims editing, carriers can turn up or down denials very easily. The AMA recently said that carriers use more than 12 million edits to deny claims.
Please note we're not suggesting that any carrier we are aware of is using this method, we merely wanted you to see that carriers definitely stand to gain money by denying claims. However, insurance carriers won't deny that they do save millions of dollars each year because insured's don't appeal claims. It has been said that 50% of all claims that have been previously denied are paid after appeal. Research and reworking denied claims accounts for about 20 to 40% of provider revenue cycle cost, so getting it right the first time is important, but not appealing is even more costly.
The AMA recently said in a RAC conference we attended in Jan. 2011 that it costs $20-$25 to submit an appeal and it costs carriers about $60 to address appeals. She also said that providers should spend as much time as possible in November each year working on appeals so that you have money coming in during January when patients are meeting their deductibles.
When a provider or a patient appeals, the carrier's own claims office personnel handles the appeal. If the patient or provider is not satisfied with the outcome, they can appeal it again to the medical director for that claim office. Note, though, that the medical director is not anxious to overturn an appeal because the claim dollars paid out will reflect on him, and medical directors are not quick to admit that mistakes have been made.
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Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nullam in nisl maximus lorem ornare condimentum vitae sed sem. Donec neque magna, sagittis at lorem ut, placerat porta nibh. Cras fringilla malesuada tincidunt. Suspendisse sagittis metus vel augue facilisis, id sollicitudin est luctus. Nunc sollicitudin diam lectus, non fermentum felis imperdiet sit amet. Mauris consectetur viverra libero id aliquet. Nulla massa tellus, faucibus at dapibus id, hendrerit vel lacus. Suspendisse est erat, interdum eget tortor vel, vestibulum varius sem. Etiam venenatis imperdiet magna, nec congue lorem convallis non. Interdum et malesuada fames ac ante ipsum primis in faucibus. Vestibulum viverra dui sit amet eros fermentum, quis vehicula ex sagittis. Quisque hendrerit dignissim ex, a aliquam lacus rhoncus non. Praesent et posuere tortor. Nullam in arcu nec purus consectetur cursus. Quisque quis imperdiet risus. Quisque vel tempus lacus.
Duis nec rutrum erat. Curabitur a urna orci. Etiam a consectetur orci, faucibus auctor est. Etiam risus ex, consectetur ac diam eget, lobortis eleifend ante. Nullam posuere, arcu at accumsan auctor, risus eros gravida enim, quis finibus dui urna vitae tortor. Praesent dignissim placerat magna, viverra dapibus tellus vehicula ut. Suspendisse quis massa rutrum, lacinia erat pretium, vulputate justo. Nullam mattis congue mauris, vel eleifend leo eleifend eget. Proin neque lectus, fermentum eu quam vestibulum, vestibulum semper felis. Morbi diam velit, pharetra eget efficitur nec, tincidunt non purus. Aliquam erat volutpat. Morbi ut nulla nisi. Sed orci ligula, finibus sed iaculis vel, ullamcorper vel urna. Donec pellentesque tristique metus eget vulputate. Integer lobortis, tellus vestibulum malesuada tristique, ligula diam blandit justo, a scelerisque mauris elit eu justo.
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Nam imperdiet massa nec orci tincidunt aliquam. Cras et purus dapibus, tristique elit non, posuere ante. Donec auctor fringilla urna, id porttitor risus pretium in. Quisque molestie, dolor lacinia bibendum volutpat, neque libero bibendum ex, vel convallis dolor quam at nibh. Mauris nibh dui, convallis vel suscipit nec, porta nec libero. Etiam sit amet ullamcorper lectus, a mattis magna.
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Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nullam in nisl maximus lorem ornare condimentum vitae sed sem. Donec neque magna, sagittis at lorem ut, placerat porta nibh. Cras fringilla malesuada tincidunt. Suspendisse sagittis metus vel augue facilisis, id sollicitudin est luctus. Nunc sollicitudin diam lectus, non fermentum felis imperdiet sit amet. Mauris consectetur viverra libero id aliquet. Nulla massa tellus, faucibus at dapibus id, hendrerit vel lacus. Suspendisse est erat, interdum eget tortor vel, vestibulum varius sem. Etiam venenatis imperdiet magna, nec congue lorem convallis non. Interdum et malesuada fames ac ante ipsum primis in faucibus. Vestibulum viverra dui sit amet eros fermentum, quis vehicula ex sagittis. Quisque hendrerit dignissim ex, a aliquam lacus rhoncus non. Praesent et posuere tortor. Nullam in arcu nec purus consectetur cursus. Quisque quis imperdiet risus. Quisque vel tempus lacus.
Duis nec rutrum erat. Curabitur a urna orci. Etiam a consectetur orci, faucibus auctor est. Etiam risus ex, consectetur ac diam eget, lobortis eleifend ante. Nullam posuere, arcu at accumsan auctor, risus eros gravida enim, quis finibus dui urna vitae tortor. Praesent dignissim placerat magna, viverra dapibus tellus vehicula ut. Suspendisse quis massa rutrum, lacinia erat pretium, vulputate justo. Nullam mattis congue mauris, vel eleifend leo eleifend eget. Proin neque lectus, fermentum eu quam vestibulum, vestibulum semper felis. Morbi diam velit, pharetra eget efficitur nec, tincidunt non purus. Aliquam erat volutpat. Morbi ut nulla nisi. Sed orci ligula, finibus sed iaculis vel, ullamcorper vel urna. Donec pellentesque tristique metus eget vulputate. Integer lobortis, tellus vestibulum malesuada tristique, ligula diam blandit justo, a scelerisque mauris elit eu justo.
Aliquam feugiat fringilla faucibus. Curabitur accumsan neque nec dignissim egestas. Etiam viverra interdum ante. Aenean blandit lectus vel commodo mollis. Nullam pretium ornare justo, vitae pharetra nisi feugiat non. Ut porta sapien vestibulum tincidunt condimentum. Vivamus tempus a ipsum semper tristique. Ut est ligula, dictum lacinia dui nec, molestie suscipit dui. Donec consectetur, dui id consequat vestibulum, dui ipsum dapibus enim, a egestas diam nisl et felis. Mauris tempus ex hendrerit, rutrum neque nec, elementum sapien. In molestie condimentum quam quis hendrerit. Suspendisse vel metus vel odio ornare semper. Ut a urna ut purus eleifend facilisis.
Pellentesque nec urna nunc. Quisque a justo eget enim aliquet eleifend at in mi. Quisque hendrerit, sem id molestie dignissim, diam nunc commodo justo, a accumsan velit urna at sem. Orci varius natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Praesent fringilla elit magna, nec egestas felis faucibus sed. Sed vel ipsum ipsum. Nam egestas gravida leo eu fermentum. Fusce eu diam eget magna consectetur tristique. Aliquam venenatis iaculis consectetur. Mauris sodales nisl sed ligula sodales, a cursus sapien molestie. Donec dapibus, ante nec dictum aliquet, leo ante dictum ligula, nec cursus lacus nibh sit amet nisl. Nullam sed dui elit. Suspendisse tincidunt, felis id accumsan condimentum, nunc arcu pretium magna, vitae rutrum ipsum dolor porttitor erat.
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In a meeting with LeadingAge NY and other associations, Department of Health (DOH) staff provided updates on Medicaid rates and other nursing home funding issues. While providers should anticipate retroactive payment adjustments in the next several Medicaid payment cycles reflecting November 2018 and January 2019 rates, DOH could provide no further information regarding July 2019 rates, which will be based on a different case mix calculation methodology. These rates are under executive review, with no specified timeline for release.
DOH is holding internal discussions on the next round of Advanced Training Initiative (ATI) funding, which is expected to distribute two years worth of funding (2018-19 and 2019-20). The Department recently requested updated information on training programs from LeadingAge NY and other authorized ATI training providers, but eligibility details and payment timing are not known. Similarly, staff are developing calculations for the supplemental payments (assessment reinvestment) and Nursing Home Quality Initiative (NHQI) adjustments that will be made at a yet-to-be-determined time in the fall.
The Department clarified that the cash receipts assessment (CRA) reimbursement amounts shown on the Jan. 1, 2019 benchmark rate list (available here) are calculated by dividing assessment payments made in 2018 (trended by about 3 percent) by 2017 resident days. In prior years, the assessment reimbursement amount had been based on the reconciled amount from two years prior. DOH has changed the methodology in hopes of reducing funding swings when the eventual reconciliation is made. The amounts shown on the benchmark list will be used for fee-for-service (FFS) payments once Division of the Budget (DOB) approval is received.
The 2017 CRA reconciliation is awaiting executive approval.
The payment adjustment schedule reflecting November 2018 and January 2019 rates remains as previously outlined:
- Medicaid Payment Cycle 2183 (check date June 24th, release date July 10th) will reflect the Nov. 1, 2018 rate retroactive to Nov. 1, 2018. This rate is the same as the July 1, 2018 rate but includes a 1.5 percent increase to the operating rate to reflect Health Care Transformation Fund funding.
- Medicaid Payment Cycle 2184 (check date July 1st, release date July 17th) will reflect the Jan. 1, 2019 rate retroactive to Jan. 1, 2019. The rate will carry forward the July 2018 case mix index (CMI) constraint adjustment amount on line 15 for homes subject to the constraint.
- Medicaid Payment Cycle 2185 (check date July 8th, release date July 24th) will reflect the REVISED Jan. 1, 2019 rates, updating the CMI constraint amount on line 15 from the July 2018 amount to January 2019. Adult Day Health Care (ADHC) rate adjustments will be included in this payment cycle.
We recommend that members verify that the retroactive adjustment amounts correspond with figures shown on their rate sheets and contact us if they do not.
DOH indicated that they intend to issue a frequently asked questions (FAQ) document on the recently adopted bed hold regulations that discontinue hospitalization bed hold payments for all residents other than those age 21 and younger or residents served by hospice. More information on this issue is available here. Although DOH was not able to share any information on July 2019 rates, the State has filed a State Plan Amendment (SPA) requesting federal approval to alter the case mix methodology effective July 1, 2019. More information on that issue is here.
We remind members that Medicaid cost reports as well as Executive Order (EO) #38 disclosures are due July 29th. Members should ensure that all needed Health Commerce System (HCS) and Financial Gateway permissions are in place for those individuals who will file and certify the report. We have received a few isolated comments from members encountering technical issues with the cost report that we have shared with DOH staff. The Department is not aware of any systemic problems but recommends that providers encountering an issue reach out to nfrates@health.ny.gov with “Cost Report Issue” in the subject line.
Medical billing is not a task you can get around in the health care industry. So, when it comes to medical billing services, the real question is: should you outsource it or not?
And the answer to the million dollar question is yes, you should.
Medical billing outsourcing services are no longer a novel approach to this aspect of a business. While it is possible to do it in-house, there are several benefits to letting someone do it for you:
1. It allows you to focus more on patient care.
Patients are and should always be your top priority. They are what ultimately feeds your bottom line, so you need to keep them coming. And let’s face it, medical staff are constantly busy, so it is always a challenge to wear the doctor and the administrative manager hat at the same time.
Ultimately, you are going to have to take a break from the doctor role to take on the administrative manager role, meaning you are taking precious time away from caring for your patients. By letting someone else who does this for a living take the strain off you, you can wear your doctor hat full-time and put all your focus into patient care.
2. It improves patient satisfaction.
This benefit goes hand in hand with the first benefit. If you are putting more focus on patient care, theoretically your patients should be more satisfied.
Patient satisfaction is also key to your bottom line. Patients are not only going to keep coming to you if they are more satisfied, but they are also going to refer their friends to you.
3. It reduces billing errors.
Billing errors can be a headache for everyone, and the busier you are the less time you have to be thorough, therefore increasing the likelihood of billing errors.
In addition to already having a better general knowledge of billing, it is part of our job to ensure accuracy in the submissions and to do so in a timely manner.
4. Your collection rate will be faster.
Money is important to your business, and it is important that you have a steady cash flow. However, billing errors can cause a delay in that cash flow.
5. It ensures billing compliance.
In any business, but especially healthcare, compliance is key. It shows the maturity of your organization to ensure compliance with things like HIPAA, and this will be deeply rooted in the process of a medical billing service.
6. It gives you access to a subject matter expert.
Experienced and well-trained medical billers have extensive knowledge on the process from start to finish and medical billing is their main focus. They will be able to take care of this business matter in a quicker, more efficient way.
7. It gives you first-hand access to innovative technology.
Healthcare is one of the quickest changing industries, and technology is right behind it. You will constantly be bombarded with new tools and technology to help with your medical billing services, but why bog you and your staff down with that when someone could stay on top of it for you?
By entrusting your medical billing to a professional company, you can be confident that we are utilizing the most up-to-date technology in the industry.
In Summary
The decision to go with a professional medical billing service is one that can change the way your business functions in a great way. It can result in fewer headaches, less overhead, fewer mistakes and ultimately, more money in your pockets. It results in additions to your bottom line in more ways than one.
If you are looking to outsource your medical billing, or even if you are looking to switch professional services, reach out to our team today to learn more about how we can help you.
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Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nullam in nisl maximus lorem ornare condimentum vitae sed sem. Donec neque magna, sagittis at lorem ut, placerat porta nibh. Cras fringilla malesuada tincidunt. Suspendisse sagittis metus vel augue facilisis, id sollicitudin est luctus. Nunc sollicitudin diam lectus, non fermentum felis imperdiet sit amet. Mauris consectetur viverra libero id aliquet. Nulla massa tellus, faucibus at dapibus id, hendrerit vel lacus. Suspendisse est erat, interdum eget tortor vel, vestibulum varius sem. Etiam venenatis imperdiet magna, nec congue lorem convallis non. Interdum et malesuada fames ac ante ipsum primis in faucibus. Vestibulum viverra dui sit amet eros fermentum, quis vehicula ex sagittis. Quisque hendrerit dignissim ex, a aliquam lacus rhoncus non. Praesent et posuere tortor. Nullam in arcu nec purus consectetur cursus. Quisque quis imperdiet risus. Quisque vel tempus lacus.
Duis nec rutrum erat. Curabitur a urna orci. Etiam a consectetur orci, faucibus auctor est. Etiam risus ex, consectetur ac diam eget, lobortis eleifend ante. Nullam posuere, arcu at accumsan auctor, risus eros gravida enim, quis finibus dui urna vitae tortor. Praesent dignissim placerat magna, viverra dapibus tellus vehicula ut. Suspendisse quis massa rutrum, lacinia erat pretium, vulputate justo. Nullam mattis congue mauris, vel eleifend leo eleifend eget. Proin neque lectus, fermentum eu quam vestibulum, vestibulum semper felis. Morbi diam velit, pharetra eget efficitur nec, tincidunt non purus. Aliquam erat volutpat. Morbi ut nulla nisi. Sed orci ligula, finibus sed iaculis vel, ullamcorper vel urna. Donec pellentesque tristique metus eget vulputate. Integer lobortis, tellus vestibulum malesuada tristique, ligula diam blandit justo, a scelerisque mauris elit eu justo.
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In a meeting with LeadingAge NY and other associations, Department of Health (DOH) staff provided updates on Medicaid rates and other nursing home funding issues. While providers should anticipate retroactive payment adjustments in the next several Medicaid payment cycles reflecting November 2018 and January 2019 rates, DOH could provide no further information regarding July 2019 rates, which will be based on a different case mix calculation methodology. These rates are under executive review, with no specified timeline for release.DOH is holding internal discussions on the next round of Advanced Training Initiative (ATI) funding, which is expected to distribute two years worth of funding (2018-19 and 2019-20). The Department recently requested updated information on training programs from LeadingAge NY and other authorized ATI training providers, but eligibility details and payment timing are not known. Similarly, staff are developing calculations for the supplemental payments (assessment reinvestment) and Nursing Home Quality Initiative (NHQI) adjustments that will be made at a yet-to-be-determined time in the fall.The Department clarified that the cash receipts assessment (CRA) reimbursement amounts shown on the Jan. 1, 2019 benchmark rate list (available here) are calculated by dividing assessment payments made in 2018 (trended by about 3 percent) by 2017 resident days. In prior years, the assessment reimbursement amount had been based on the reconciled amount from two years prior. DOH has changed the methodology in hopes of reducing funding swings when the eventual reconciliation is made. The amounts shown on the benchmark list will be used for fee-for-service (FFS) payments once Division of the Budget (DOB) approval is received.The 2017 CRA reconciliation is awaiting executive approval.The payment adjustment schedule reflecting November 2018 and January 2019 rates remains as previously outlined:
- Medicaid Payment Cycle 2183 (check date June 24th, release date July 10th) will reflect the Nov. 1, 2018 rate retroactive to Nov. 1, 2018. This rate is the same as the July 1, 2018 rate but includes a 1.5 percent increase to the operating rate to reflect Health Care Transformation Fund funding.
- Medicaid Payment Cycle 2184 (check date July 1st, release date July 17th) will reflect the Jan. 1, 2019 rate retroactive to Jan. 1, 2019. The rate will carry forward the July 2018 case mix index (CMI) constraint adjustment amount on line 15 for homes subject to the constraint.
- Medicaid Payment Cycle 2185 (check date July 8th, release date July 24th) will reflect the REVISED Jan. 1, 2019 rates, updating the CMI constraint amount on line 15 from the July 2018 amount to January 2019. Adult Day Health Care (ADHC) rate adjustments will be included in this payment cycle.
We recommend that members verify that the retroactive adjustment amounts correspond with figures shown on their rate sheets and contact us if they do not.DOH indicated that they intend to issue a frequently asked questions (FAQ) document on the recently adopted bed hold regulations that discontinue hospitalization bed hold payments for all residents other than those age 21 and younger or residents served by hospice. More information on this issue is available here. Although DOH was not able to share any information on July 2019 rates, the State has filed a State Plan Amendment (SPA) requesting federal approval to alter the case mix methodology effective July 1, 2019. More information on that issue is here.We remind members that Medicaid cost reports as well as Executive Order (EO) #38 disclosures are due July 29th. Members should ensure that all needed Health Commerce System (HCS) and Financial Gateway permissions are in place for those individuals who will file and certify the report. We have received a few isolated comments from members encountering technical issues with the cost report that we have shared with DOH staff. The Department is not aware of any systemic problems but recommends that providers encountering an issue reach out to nfrates@health.ny.gov with “Cost Report Issue” in the subject line.
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Executive Order 202.30 - Nursing Home and Adult Care Facility Staff Testing Requirement
FAQ #1 – May 12, 2020
1. If a staff member has a positive test, should the individual be re-tested at the end of the furlough before returning to work?
The diagnostic test is a polymerase chain reaction (PCR) test that detects viral nucleic acid. Even after there is no remaining live virus present capable of causing an infection, there still might be remnant viral nucleic acid present that can be detected by PCR and cause a positive result. The Centers for Disease Control and Prevention (CDC) has described studies using viral culture which found live virus capable of causing infection for only 9 days after the onset of symptoms.
Facilities may, but are not required to, have staff test negative before returning to work. CDC points out that more stringent requirements than those for the general community might be appropriate for some individuals, such as those who live or work in settings with vulnerable persons. New York State has adopted more stringent requirements that nursing home personnel must be furloughed until 14 days from the onset of illness (and at least 3 days have passed since resolution of fever without use of fever-reducing medication and respiratory symptoms are improving) for symptomatic staff and for 14 days from the first positive test for asymptomatic staff.
2. How frequently will personnel have to be tested?
Executive Order No. 202.30 requires twice per week testing of all personnel of all nursing homes and adult care facilities, including all adult homes, enriched housing programs and assisted living residences.
3. Will personnel have to be excluded from work while waiting for test results?
If personnel are asymptomatic and being tested solely for the purpose of meeting the requirements of Executive Order No. 202.30, then they do not have to be excluded from work while waiting for test results.
4. Who is included in the testing requirement for personnel?
The requirement includes but is not limited to employees, contract staff, per diem staff, medical staff, operators, administrators, and volunteers. Staff who are working from home, on leave, or otherwise not at the same site as residents do not need to be tested as long as they remain offsite. Staff who work at a facility on three days per week or less only need to be tested one time per week. Staff of home health (LHCSA, CHHA) and hospice agencies which serve patients residing in the facility are not personnel who must be tested pursuant to EO 202.30.
5. Are staff who have had a positive diagnostic test for COVID-19 or a positive serologic test for IgG against SARS-CoV-2 in the past included in the requirement to be tested twice per week?
At this time, staff who have documentation of a positive diagnostic test for COVID-19 or a positive serologic test for IgG against SARS-CoV-2 are currently exempt from this testing requirement. This exemption might change as more is learned about immunity following COVID-19.
6. Who is responsible for paying for the testing required of personnel of nursing homes and adult care facilities?
Facilities are responsible for providing testing for their employees, including assuming responsibility for the costs of testing. One option that some facilities may be able to access includes the drive-through and walk-in sites that are operated by New York State at no charge to the individual. Testing is by appointment only. Individuals who would like to be tested can either register online at: https://covid19screening.health.ny.gov/ or by calling the COVID-19 hotline at 888-364-3065. The locations of these sites are attached as Attachment 1.
7. What laboratory should nursing homes and adult care facilities use to perform testing to meet the new requirement?
Facilities are responsible for establishing relationships with laboratories, including local hospitals or commercial laboratories, to perform the required testing for their employees. Wadsworth Center is currently performing testing for other priority specimens, including those collected from nursing home residents.
8. How should testing be conducted for personnel who work at multiple facilities?
Personnel who work at multiple facilities only need to be tested twice per week. Those results may be used to meet the testing requirements at any facility, as long as documentation of the test result is provided to each facility. Each employer facility must maintain appropriate documentation of the test results.
9. How do facilities obtain collection kits and personal protective equipment for required testing?
If facilities are unable to obtain supplies needed for the testing requirement through normal distributors, they should request these supplies through their local Office of Emergency Management.
10. Can nurses in adult care facilities be used to collect specimens for testing?
Executive Order 202 made changes to the scope of practice laws concerning the collection of throat or nasopharyngeal swab specimens from individuals suspected of being infected by COVID-19, for purposes of testing. Accordingly, during the course of this emergency, nurses employed by an adult care facility (ACF) are permitted to collect swab specimens for ACF staff and residents. Additionally, other clinical staff who have received appropriate training regarding specimen collection may collect such specimens. More information relating to specimen collection is available on the Department of Health's website at https://coronavirus.health.ny.gov/covid-19-testing.
Attachment 1
Drive-through and community Center testing sites.
Albany/ DT /Albany/SUNY, 1400 Washington Avenue Albany, NY 12222
Bronx/ CC /Morris Heights/Morris Heights Health Center, 1227 Edward L. Grant Highway Bronx, NY 10452
Bronx/ CC /Mott Haven/Tres Puentes Community Health Center, 271 E. 138th Street Bronx, NY 10454
Bronx/ DT /Bedford Park/Lehman College, 2925 Goulden Avenue Bronx, NY 10468
Bronx/ DT /Co-Op City/The Mall at Bay Plaza, 200 Baychester Avenue Bronx, NY 10475
Broome/ DT /Binghamton/Binghamton University Event Center Parking Lot, 4400 Vestal Pkwy. E. Vestal, NY 13850
Erie/ DT /Buffalo/Buffalo Sabres Lot, 125 Perry Street Buffalo, NY 14204
Kings/ CC /Brownsville/Brownsville Family Care, 592 Rockaway Avenue Brooklyn, NY 11212
Kings/ CC /Flatbush/Brookdale Family Care, 1095 Flatbush Avenue Brooklyn, NY 11226
Kings/ CC /Sunset Park/Lutheran Augustana Center, 5434 2nd Avenue Brooklyn, NY 11220
Kings/ CC /Brooklyn/Bedford Stuyvesant Family Health Center, 325 Herkimer Street Brooklyn, NY 11216
Kings/ DT /Flatbush/Commercial Building, 2360 Bedford Avenue Brooklyn, NY 11226
Monroe/ DT /Rochester/Monroe County Community College, 1000 E. Henrietta Road, Rochester, NY 14623
Nassau/ DT /Jones Beach/Jones Beach State Park Roosevelt Nature Center, 1 Ocean Parkway Wantagh, NY 11793
New York/ CC /Harlem/Institute Family Health, 1824 Madison Avenue New York, NY 10035
New York/ CC /Harlem/Ryan Health/Frederick Douglass, 2381 Frederick Douglass Blvd., New York, NY 10027
New York/ CC /Washington Heights/Amsterdam Medical Practice, 2360 Amsterdam Avenue, New York, NY 10033
Niagara/ DT /Sanborn/Niagara County Community College, 3111 Saunders Settlement Rd, Sanborn, NY 14132
Oneida/ DT /Utica-Rome/Griffiss International Airport, 592 Hanger Road, Rome, NY 13441
Queens/ CC /Corona/Plaza del Sol Family Health Center, 37-16 108th Street Corona, NY 11368
Queens/ CC /Jamaica/First Presbyterian, 89-60 164th Street Jamaica, NY 11432
Queens/ CC /Jamaica/Joseph P. Addabbo Health Center, 118-11 Guy R Brewer Blvd. Jamaica, NY 11434
Queens/ DT /Ozone Park/Aqueduct Racetrack, 110-00 Rockaway Blvd Queens, NY 11420
Richmond/ DT /Staten Island/South Beach Psychiatric, 777 Seaview Ave Staten Island NY, 10305
Rockland/ CC /Haverstraw/Hudson River Healthcare, 31 W. Broad Street Haverstraw, NY 10927
Rockland/ DT /Bear Mountain/Anthony Wayne Rec Area, Exit 17 Palisades Pkwy, Bear Mountain, NY 10911
Suffolk/ DT /Stony Brook/Stony Brook University, 100 Nicolls Rd. South P Lot, Stony Brook, NY 11794
Westchester/ CC /Mt. Vernon/Mt. Vernon Health, 107 W. 4th Street Mount Vernon, NY 10550
Westchester/ CC /New Rochelle/New Rochelle Hospital, 16 Guion Place New Rochelle, NY 10801
Westchester/ CC /Yonkers/Hudson River Healthcare, 2 Park Avenue Yonkers, NY 10703
Westchester/ DT /New Rochelle/Glen Island Park, 250 Weyman Avenue, New Rochelle, NY 10805
The federal government on Friday announced the distribution of almost $4.9 billion in COVID-19 relief funds directly to skilled nursing facilities, the first specific tranche of stimulus money for the industry released since the start of the pandemic.
Each skilled nursing facility in the country will receive a baseline payment of $50,000, plus an additional $2,500 per bed, the Department of Health and Human Services (HHS) announced. The money, part of the CARES Act stimulus package, will be available to all facilities with six or more certified beds.
“This funding secured by President Trump will help nursing homes keep the seniors they care for safe during the COVID-19 pandemic,” HHS secretary Alex Azar said in a statement. “The Trump administration is providing every resource we can, from funding and direct PPE shipments to regulatory flexibility and infection control consultations, to protect seniors in nursing homes and those who care for them.”
As with other rounds of CARES Act funding, providers must agree to certain terms and conditions in order to accept the cash, and must comply with future audit and reporting rules, according to HHS.
The Friday distribution marks the first dedicated relief for nursing homes, which have served as the epicenter of the coronavirus pandemic in the United States.
HHS and the Centers for Medicare & Medicaid Services (CMS) had previously released $50 billion in aid to all Medicare providers, though that category leaves out the significant proportion of nursing homes that rely on Medicaid funding as their primary revenue stream.
While the government has, as Azar noted, announced a plan to deliver PPE to nursing homes, the aid took the form of two weeks’ worth of supplies split over two deliveries — with a delivery date of July 4 at the latest.
HHS acknowledged the financial stress that nursing home operators face while fighting COVID-19.
“Since the beginning of 2020, SNFs have experienced up to a 6 percent decline in their patient population as current and potential residents choose other care settings, or as current residents pass away. In addition to nursing home residents, many SNF employees have also been diagnosed with COVID-19,” the agency observed. “These additional funds may help nursing homes address critical needs such as labor, scaling up their testing capacity, acquiring personal protective equipment, and a range of other expenses directly linked to this pandemic.”
The terms and conditions to which providers must agree are largely similar to the ones required under the previous Medicare relief rounds, with a few key differences. Operators do not need to have billed Medicare for any services in 2019 to receive the funds, according to Arnall Golden Gregory partner Hedy Silver Rubinger, chair of the firm’s health care practice; they also do not have to furnish the government with information about 2018 operating expenses.
Providers had always been required to provide HHS with a quarterly accounting of how they spend their relief money if that figure exceeds $150,000, but the skilled nursing relief terms now include Paycheck Protection Program (PPP) funding toward that threshold — a move that indicates HHS is cautioning against “double dipping,” Rubinger said.
Industry leaders have pled with the government to set aside funds specifically for post-acute and long-term care providers, though Friday’s total falls short of the $10 billion the American Health Care Association (AHCA) has repeatedly requested.
AHCA president and CEO Mark Parkinson thanked HHS for the $4.9 billion injection Friday morning, though he also noted that the round leaves out other types of long-term care providers.
“Notably, assisted living communities have yet to receive any direct aid, despite also serving vulnerable seniors,” Parkinson said in a statement. “While building on support received from HHS, we are asking for additional consideration for all long term care facilities, whether it be in regard to additional testing, personal protective equipment, or funding.”
Katie Smith Sloan, president and CEO of non-profit industry group LeadingAge, echoed Parkinson’s sentiment, welcoming the support but emphasizing that more will be necessary.
“These funds are a start in covering nursing homes’ extraordinary expenses related to this public health crisis, but will only go so far in addressing providers’ growing financial needs as this pandemic continues,” Sloan said in a statement.
Nursing homes have faced elevated staffing, PPE, and testing costs since the start of the pandemic, a factor that’s been compounded by a decline in post-acute care patients amid a blanket pause on non-emergency surgeries.
Those costs are only projected to increase as state and regional economies gradually reopen. CMS’s plan for lifting visitation bans on nursing homes calls for a single baseline test of all nursing home residents and staff, which AHCA estimated would cost $440 million.
Meeting CMS’s guidance to test all staff members once per week, according to AHCA, will run $1 billion per month, and states can also implement their own guidelines that would only add to that cost; New York, for instance, has mandated twice-weekly testing for staffers.
This is a developing story. Please check back for updates.
