AHCA: COVID-19 Update #17 - Call on the Public for Supplies

Stephen Hanse in Clinical & Quality

In This COVID-19 Update:

  • Public Calls for Supplies
  • Preparing for States’ Use of Increased FMAP Funds  
  • Conversations Revisiting End-of-Life Wishes and Advance Directives 
  • SNF Relief on Quality Reporting and Value-Based Purchasing Programs   

Public Call for Supplies 

PPE supplies are running dangerously low in most long term care facilities. Many facilities and states are issuing calls for public donations. AHCA/NCAL has developed a template to serve as a call for donations. 

Preparing for States’ Use of Increased FMAP Funds  

Due to significant increases in unemployment from business closures and related furloughs, states may choose to use any portion of last week’s 6.2% increase in federal Medicaid payments to provide Medicaid coverage for the newly unemployed and, very likely, uninsured. Such decisions will result in less Medicaid funding for provider rate increases to cover COVID-related costs.  

However, on March 21, the federal government announced that it is considering a special enrollment period for Affordable Care Act Health Insurance Exchange (HIX) coverage. Individuals purchase health care coverage through the HIX. The special enrollment period would be aimed at offering lower cost coverage to the individuals with reduced incomes if made available. Such a special enrollment period might influence state decision making on how much of the 6.2% federal Medicaid funding should be used on coverage versus COVID-related provider expenses.  

Suggested Action Step: State Affiliates should take steps to assess state decision on how to divide funds between Medicaid coverage for the uninsured and provider rate increased to address new COVID-related costs. See a more detailed discussion.   

Conversations Revisiting End-of-Life Wishes and Advance Directives 

In light of the high mortality rate (20-30%) for nursing home and assisted living community residents who become infected with COVID-19, we urge you to: 

  • Have conversations with residents and families about their end-of-life wishes now before someone becomes ill.   
  • Ensure residents’ advance directives, Provider Orders for Life-Sustaining Treatment (POLST), and other documents are all up to date with current documented wishes, and physician orders are consistent with these wishes. 

In the coming weeks, we expect to have hospital surges across the country that will exceed the capacity to transfer nursing homes and assisted living communities' residents with suspected or confirmed COVID-19. Discussing with residents and families now as to how they want to be cared for in place in the nursing home or assisted living community will be helpful to inform how to best meet their wishes, in advance of the anticipated continued spread of COVID-19, and its increased strain on the health care system.

CMS Announces SNF QRP and VBP Relief in Response to COVID-19 

On March 22, the Centers for Medicare & Medicaid Services (CMS) announced administrative burden relief for providers participating in various quality programs during the COVID-19 outbreak. CMS recognizes that quality measure data collection and reporting for services furnished during this time of emergency may not be reflective of their true level of performance on measures such as cost and readmissions and seeks to hold organizations harmless for not submitting data during this period. Specific to SNFs, CMS is implementing exceptions and extensions for upcoming measure reporting and data submission deadlines for: 

Skilled Nursing Facility Quality Reporting Program 

  • 2019 Data Submission: April/May deadlines for October 1, 2019 – December 31, 2019 (Q4) data submission is now optional.  If Q4 is submitted, it will be used to calculate the 2019 performance and payment (where appropriate). 
  • 2020 Data Submission: Data from January 1, 2020 through June 30, 2020 (Q1-Q2) does not need to be submitted to CMS for purposes of complying with SNF QRP requirements. 
  • 2020 Claims-based measures: No data reflecting services provided January 1, 2020 through June 30, 2020 will be used in CMS’s calculations.   

Skilled Nursing Facility Value-Based Purchasing (VBP) Program  

  • Qualifying claims will be excluded from the claims-based SNF 30-Day All-Cause Readmission Measure (SNFRM; NQF #2510) calculation for Q1-Q2. 

CMS will continue monitoring the developing COVID-19 situation and assess options to bring additional relief to providers so they can focus on caring for patients. 

For additional questions, please email COVID19@ahca.org and visit www.ahcancal.org/coronavirus for more information and resources.