Over the last few weeks, CMS and the President have enacted legislation and released guidance to assist the senior living industry in coping with the impact of COVID-19. We recognize the elderly residents of our country are the most vulnerable population and your days are filled caring for your population’s needs and health. Our senior living professionals have written this article to highlight new regulations impacting the industry and offer practical tips for guarding your facility's financial health through the COVID-19 outbreak.
Amidst rapid hourly changes in contending with the coronavirus and its far-reaching impacts, the way you run your facility has changed. Along with this change comes an increase in expenditures. To ensure that your facility is getting much needed financial relief and being properly reimbursed for the full impact of COVID-19, we recommend tracking your expenditures related to the coronavirus. Expenditures related to COVID-19 go beyond the cost of additional Personal Protective Equipment (PPE), they will likely include additional direct care staffing, along with housekeeping, dietary and laundry staffing, and supplies needed to maintain the heightened level of hygiene required to combat the spread of COVID-19 in your facility.
CMS issues waiver of 3-Day Stay and Spell of Illness
On March 14, Centers for Medicare and Medicaid Services (CMS) issued two waivers to aid skilled nursing facilities in addressing the national COVID-19 outbreak. CMS is waiving both the 3-Day Stay and Spell of Illness requirements. Read the COVID-19 Emergency Declaration.
Key provisions to consider with regard to 3-midnight qualifying stay requirement:
- The exception applies to traditional Medicare coverage only (Medicare Advantage plans may or may not follow this exception);
- It is in effect as of March 1, 2020, and will only be in effect while public health emergency is declared;
- Applies only to beneficiaries affected by the emergency or who experience dislocations;
- Providers have to document medical necessity and clinical reasons for not meeting 3-midnight requirement, understanding that the intent of this provision is to free up hospital beds and reduce potential risk of exposure to the patient;
- Providers are to use condition code “DR” on the claims.
Read additional AHCA clarifications and guidance regarding the waivers of 3-Day Stay and Spell of Illness requirements.
MDS completion and submission waivers
CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set (MDS) assessments and transmissions. CMS has yet to issue technical guidance on how to implement.
On March 22, 2020, CMS announced temporary administrative burden relief related to Quality Reporting which includes certain SNF-specific changes:
- Quality Reporting Program (QRP) April/May deadline for 10/1/19 - 12/31/19 data submission is optional for those facilities that have not yet submitted data;
- Facilities do not need to submit 1/1/20 - 6/30/20 data for purposes of compliance with QRP;
- CMS will not use any data for the first 2 quarters of 2020, 1/1/20 - 6/30/20, in its calculations;
- Claims for 1/1/20 - 6/30/20 will be excluded from calculation of all-cause readmission measures that result in value-based purchasing adjustments.
Read the full CMS press release.
Families First Coronavirus Response Act (FFCRA)
On March 18, 2020, the President signed into law, H.R. 6201, the Families First Coronavirus Response Act. The legislation eliminates patient cost-sharing for COVID-19 testing and related services, establishes an emergency paid leave program, and expands unemployment and nutrition assistance. Moreover, the bill provides a temporary 6.2% increase in Federal Medical Assistance Percentages (FMAP) for each calendar quarter occurring during an emergency period.
FMAP is the federal portion of funds for state Medicaid programs. With this temporary increase states can use the increased federal funds for any portion of the state Medicaid program. Due to significant increases in unemployment from business closures, the increase may be used to provide Medicaid coverage for the newly unemployed and uninsured. This would result in less funding for provider rate increases to cover COVID-19 related costs. However, on March 21, 2020, the federal government also announced that it is considering a special enrollment period for Affordable Care Act Health Insurance Exchange coverage. A special enrollment period would offer lower cost coverage to individuals with reduced incomes and could influence how the FMAP increase will be used, possibly resulting in more being allocated to covering provider rates. As of today, it is still unclear how states will use the increased funds.
A table released by AHCA on March 14, 2020, provides estimates of the increase in Federal Medicaid funding from FMAP assuming the increase is in effect January through December 2020.
There are two provisions of the FFCRA that deal with paid leave provisions for employees. BerryDunn's employee benefits consultants provide insight and clarity on the paid leave provisions for employees.
Prioritization of survey activities
CMS released guidance prioritizing and suspending most federal and state survey agency (SSA) surveys, and delaying revisit surveys, for the next three weeks beginning on March 20, 2020, for all nursing homes. Standard surveys and non-Immediate Jeopardy (IJ) related onsite surveys will be suspended for three weeks. Complaints and facility-reported incidents that are considered at the IJ level will be conducted during this time. Facilities are encouraged to use the CDC developed COVID-19 Focused Survey for Nursing Homes. Get additional CMS guidance.
Coronavirus Aid, Relief, and Economic Security (CARES) Act
On March 25, 2020, the US Senate unanimously approved the $2 trillion CARES Act (The “Act”). It is anticipated that the House of Representatives will vote on the Act today, March 27, 2020. The White House has signaled that it will sign the measure as approved by the Senate.
Major provisions of the proposed legislation include:
- The Medicare 2% sequester will be temporarily suspended starting in late May 2020.
- $150 million for modifications of existing hospital, nursing home, and “domiciliary facilities” undertaken as part of COVID-19 response.
- $65 million for housing for the elderly and people with disabilities for rental assistance, service coordinators and support services for the more than 114,000 affordable households for the elderly, and more than 30,000 affordable households for low-income people with disabilities.
- $2.8 million to provide staff treating veterans living at Armed Forces Retirement Homes with the personal protective equipment they need. The funding provides this and other necessary equipment and staffing support to help minimize the spread of the coronavirus among residents.
- $955 million for the Administration for Community Living to support nutrition programs, home- and community-based services, support for family caregivers, and expand oversight and protections for seniors and individuals with disabilities.
- $200 million for the Centers for Medicare & Medicaid Services to assist nursing homes with infection control and support states’ efforts to prevent the spread of the coronavirus in nursing homes.
Practical tips for monitoring and maintaining your organization’s financial health
As we navigate these next few months, facilities will face challenges to maintain the health and safety of their residents and staff as well as the financial health of the organization. Some things you should be doing now:
- Calculate your working capital and cash position weekly or bi-weekly.
- Perform cash flow projections for the next few months. Be sure the timing of your cash receipts will cover payroll and supplies expenditures each week.
- Contact your lenders to obtain or increase available working capital lines of credit.
- Ascertain if you can release any investment balances if needed.
We are here to help
Please contact the BerryDunn senior living team if you have any questions, or would like to discuss your specific situation.