Nursing Facility Providers COVID-19 Updates and Q&A with ...

1 Links to Handouts at End Welcome Nursing Facility Providers ! COVID-19 Updates and Q&A with LTCR. and DSHS. December 8, 2021. For more information: Web: COVID-19 -provider-information Email: Phone: 512-438-3161. COVID-19 Q&A. Panelist Kevin Knippa Senior Policy Specialist Policy & Rules Long-term Care Regulation _____. 2. COVID-19 Q&A. Panelist David Gruber Associate Commissioner for Regional and Local Health Operations DSHS. 3. COVID-19 Q&A. Panelist Kevin Knippa Senior Policy Specialist Policy & Rules Long-term Care Regulation _____. 4. Handouts Handouts included as attachments on this webinar: NF Visitation Emergency Rules NF Mitigation Emergency Rules PL 2020-49, Process to Request Free COVID-19 Point of Care Antigen Test Kits Design Institute for Health, LTC Staff Wellbeing Study 5. COVID-19 Q&A. Panelist Rose Lewis, Social Service Designer Jessica Murray, Design Fellow Design Institute for Health Dell Medical School 6.

2 COVID-19 Q&A. Panelist Kevin Knippa Senior Policy Specialist Policy & Rules Long-term Care Regulation _____. 7. State Long-Term Care Ombudsman Program Statewide phone: 800-252-2412. Statewide email: State Ombudsman: Patty Ducayet, 512-438-4356 (or). Facebook: 8. Next Webinar NF Provider Webinars are held on a monthly basis. The next webinar will be held on January 12th. The recording and slides from today's webinar will be posted to the Nursing Facility Provider Portal and sent out via GovDelivery alerts. They are typically posted/sent out within a few days after each webinar. 9. COVID-19 vaccination requirements for staff CMS Suspends Enforcement of COVID-19 Vaccine Requirement for Health Care Staff in Medicare and Medicaid Certified Providers The Centers for Medicare and Medicaid Services has issued Quality Safety & Oversight Memo QSO-22-04-ALL (PDF). The memo states CMS will not enforce the new rule regarding vaccination of health care workers or requirements for policies and procedures in certified Medicare/Medicaid Providers and suppliers while there are court-ordered injunctions in place prohibiting enforcement.

3 Read the details. 10. COVID-19 vaccination requirements for staff HHSC is aware of CMS's interim final rule with comment period that establishes COVID-19 vaccination requirements for staff at certain Medicare- and Medicaid-certified Providers and suppliers. On November 15, 2021, the state of Texas initiated a lawsuit to challenge the rule. HHSC cannot comment on the pending litigation and recommends all Providers and facilities speak with their legal counsel to determine how to proceed. 11. COVID-19 Q&A. Panelist Robert Ochoa Senior Policy Specialist Policy & Rules Long-term Care Regulation _____. 12. Alerts November 15, 2021: Nov. 10 Recording of NF COVID-19 . Webinar with LTCR Available A recording of the November 10, 2021, NF. COVID-19 webinar with LTCR and DSHS is available for those unable to attend. Listen to the webinar recording here. Read the webinar slide presentation (PDF). Email LTCR Policy for the transcript.

4 13. Alerts November 18, 2021: CMS Issues Changes to COVID-19 . Survey Activities and Increases Oversight in Nursing Homes CMS issued Quality Safety & Oversight Memo QSO-22-02-ALL (PDF). 14. CMS: QSO-22-02-ALL. Revises the criteria for conducting COVID-19 Focused Infection Control Surveys Issues guidance for resuming recertification surveys Issues temporary guidance and minor flexibilities related to complaint investigations 15. Alerts November 18, 2021: HHSC published Provider Letter 2021-29 - End of Temporary Suspension of Certain LTCR Requirements During COVID-19 Outbreak describing rule suspensions that ended. The suspension of License Application and Renewal Timeline Requirements expired on October 3, 2021. For licenses that expired before October 3, 2021, the renewal application must be submitted by January 2, 2022. Any license that expires on or after October 3, 2021, must be renewed according to the licensure application timelines and requirements as applicable to the Facility type.

5 Failure to submit a licensure application timely could result in the closure of CMS certifications and suspension of services and activities that require a license. A provider who fails to submit a timely renewal application may need to apply for an initial license to obtain compliance with licensure regulations. 16. Alerts November 28, 2021: NF COVID-19 Visitation Rule Revised Effective Nov. 28. HHSC Long-term Care Regulation has published a revised Nursing Facility COVID-19 Visitation Emergency Rule (PDF). It became effective November 28, 2021. The revised rule requires certified and licensed- only NFs to follow CMS guidance regarding visitation during the COVID-19 public health emergency. 17. Alerts November 28, 2021: NF COVID-19 Mitigation and Response Rule Revised Effective Nov. 28. HHSC Long-term Care Regulation has published a revised Nursing Facility COVID-19 Mitigation and Response Emergency Rule (PDF). It became effective November 28, 2021.

6 18. Alerts December 1, 2021: HHSC Long-term Care Regulation has published Provider Letter 2020-08. (revised) - Requirement to Submit Facility Resident Death Report. The revisions clarify that hospital- based SNFs are not required to submit Facility resident death reports via TULIP. 19. Alerts December 3, 2021: Webinar: NF Enhanced Barrier Precautions with HHSC and DSHS. HHSC and DSHS will host a webinar on enhanced barrier precautions for Nursing Facility infection preventionists and related staff. Wednesday Dec. 15, 2021. 11 noon Register for the webinar 20. Reminder NFs can still request BinaxNOW covid - 19 point of care antigen test kits from HHSC. PL 2020-49 provides the information on how to request the test kits. The requested test kits can be used to test any individual, including residents, staff, and visitors. 21. COVID-19 Q&A. Panelist Bijendra Bhandari Infection Prevention Policy Specialist Policy & Rules Long-term Care Regulation _____.

7 Updated COVID-19 Mitigation Rule Quarantine Review 22. Reminder COVID-19 cases are on the rise again in LTCFs and in the community. The emergence of new variants and the rise in new covid - 19 cases requires extra vigilance. Remind staff, residents and visitors of the importance of following infection prevention and control requirements to help prevent the spread of COVID-19 infection. 23. Updated COVID-19 Mitigation Rule 24. Updated COVID-19 . Mitigation Rule HHSC Long-term Care Regulation has published a revised Nursing Facility COVID-19 Mitigation and Response Emergency Rule (PDF). 25. Updated COVID-19 . Mitigation Rule Key changes for Fully-Vaccinated Staff: A NF's infection prevention and control program may allow fully-vaccinated staff to not wear a facemask or other PPE or maintain physical distancing when they are in well-defined areas that are restricted from resident access, in accordance with CDC guidance.

8 26. Updated COVID-19 . Mitigation Rule The following provisions from the covid - 19 Response Emergency Rule have not changed: Residents must be screened for signs and symptoms of COVID-19 at least once per day, regardless of the resident's vaccination status. Staff must be screened for signs and symptoms of COVID-19 before each shift. NFs are still required to have written infection prevention and control policies, which include staff use of PPE, to prevent the spread of COVID-19 . 27. Updated COVID-19 . Mitigation Rule The following provisions from the COVID-19 . Response Emergency Rule have not changed: NFs must cohort residents by COVID-19 . status per CDC guidance. NFs must develop and implement a policy regarding staff working with other LTC. Providers to limit the sharing of staff with other LTC Providers , unless required in order to maintain adequate staffing at a Facility . NFs must report COVID-19 cases to HHSC.

9 See PL 2021-04 for more information on the HHSC COVID-19 reporting requirement and PL 2020-46 for additional reporting requirements. 28. PPE Update: KN95s KN95 respirators may be used in non-resident areas, and while in all areas of the Facility outside the Isolation ( COVID-19 positive). zone and Quarantine (Unknown COVID-19 ). zone. Additionally, the CDC guidance states when used solely for source control ( , outside Isolation and Quarantine zones), the KN95. respirator could be used for an entire shift unless they become soiled, damaged, or hard to breathe through. (continued on next slide). 29. PPE Update: KN95s Full PPE is required (NIOSH-approved N95 or equivalent or higher-level respirator, gowns, gloves, and eye protection) for healthcare personnel working inside the Isolation ( COVID-19 . positive) zone and Quarantine (Unknown COVID-19 ) zones (CDC guidance). KN95 respirators should NOT be used as a part of the PPE while working in Isolation or Quarantine zones.

10 30. Quarantine Review 31. Quarantine Guidance Summary for Residents Scenario Fully Unvaccinated /. Vaccinated/ Not in 90-day Recovered* recovery period 1. New admission / No Quarantine Quarantine readmission 2. Gone overnight No Quarantine Quarantine 3. Exposure/Close No Quarantine Quarantine contact to COVID-19 except for certain scenarios+. 4. Exhibiting Quarantine Quarantine Symptoms *Recovered from COVID-19 in the past 90 days +Persons who are immunocompromised, or if ordered by the local health authority A close contact is defined as anyone who has close contact (within 6. feet for a cumulative total of 15 minutes over 24 hours) to someone with COVID-19 infection. 32. Return to Work Guidance Summary for Staff Scenario Fully Vaccinated/ Unvaccinated / Not Recovered in 90-day recovery period 1. Higher-risk No work restrictions Depends on PPE used Exposure except for certain during exposure scenarios+. 2. Lower-risk No work restrictions No work restrictions or Exposure testing.