Coronavirus

In response to the coronavirus (COVID-19) pandemic, we are working with the federal government to ensure nursing homes, assisted living communities, and intermediate care facilities for individuals with intellectual disabilities receive necessary supplies and guidance to prevent the spread of this virus.

Visit this website regularly for the latest information that AHCA/NCAL has to share with long term care providers about COVID-19.

How You Can Help Prevent the Spread of COVID-19

Providers

Please note that skilled nursing providers should consult the guidance put forth by CMS and the CDC, and assisted living communities should consult CDC guidance. Providers should also check their local and state health departments for updates and potentially stricter guidance, but these are general, national prevention and containment tips:

Infection Control: Maintain infection control policies and procedures, updated where needed and increase transmission-based precautions.

Staff: #GetVaccinated! Regularly wash your hands and use PPE where appropriate. Stay home if you're sick.

Limit Interactions: Implement social distancing within the facility where possible to help prevent the spread of infection.

PPE: Regularly review federal and state guidance on appropriate use of masks, gowns, gloves, etc. and maintain your inventory.

Communicate: Report suspected or confirmed cases to authorities. Keep residents, families and staff informed about your developing situation. Prepare for media inquiries.

Engagement: Follow government guidelines for safe in-person visitations, keep residents connected with loved ones remotely, and offer meaningful activities adapted for this situation.

If a staff member shows symptoms of COVID-19: Have them go home immediately.

If a resident shows symptoms of COVID-19: Implement droplet precaution, and contact the local health department.

Families

Coronavirus (COVID-19) poses a serious threat to older adults (especially 80 years old and older) and those with underlying health conditions. This is why in certain circumstances the federal government and many state governments are restricting visitors to nursing homes and assisted living communities. Adaptations (e.g., limited indoor and outdoor visits) and exceptions on a case-by-case basis (e.g., end-of-life or compassionate care visits) may be made. We understand this is difficult, but the safety and wellbeing of your loved one is our top priority.

Here’s how you can continue to stay in touch with them, and how you can help:

Communicate with your loved ones through alternative ways for the time being, whether by phone, video, social media, or other methods. Ask the facility about ways they can help with this.
Make sure your loved one’s facility has your emergency contact information. The facility may need to communicate with you about any developments regarding your loved one or about the facility as a whole.

Many long term care facilities are only permitted to share information about a resident to a designated health representative. Work together as a family unit to share information to keep everyone informed.

If you must come to the facility, coordinate with the staff ahead of time. Learn more about how you can prepare for a visit to a long term care facility.

They may ask you some questions, take your temperature, have you take a COVID test, and/or make sure you’re wearing proper protective equipment (like a mask) when you arrive. This is to make sure you do not pose as a potential risk to residents and staff.
If you are asked to not enter the building, please understand this is for the safety of your loved one and everyone else in the building. Nursing homes and assisted living communities are following direction from the government to prevent the spread of this virus.
If you are permitted in, please wash your hands or use alcohol-based hand sanitizer immediately upon entering and throughout your visit. Wear a mask and any other protective equipment as directed by the facility. Avoid touching your loved ones or other individuals in the building. Again, we know this is difficult, but the virus is very contagious and social distancing is important at this time.

Do your part to help slow the spread of COVID-19. High community spread is linked to outbreaks in nursing homes. Follow the CDC’s recommendations to protect yourself and others. Get the COVID-19 vaccine, when you are eligible.
Warn your loved ones about potential scammers during this crisis and encourage them to be cautious.

Residents

Coronavirus (COVID-19) poses a serious threat to older adults (especially 80 years old and older) and those with underlying health conditions. This is why in certain circumstances the federal government and many state governments are restricting visitors to nursing homes and assisted living communities. We understand this is a difficult and stressful time. Those who work in long term care facilities are focused on your safety and wellbeing.

Here’s how you can continue to stay in touch with your loved ones, and how you can help:

Ask the facility about other ways you can communicate with your loved ones, whether by phone, video or social media.
If you haven't already, get the COVID-19 vaccine. Your facility is working with a pharmacy or state/local officials to offer vaccinations and can provide more specific information about how and when this will work.
Follow everyday preventive actions such as:

Washing your hands or using alcohol-based hand sanitizers
Covering your cough and sneezes
Wearing a mask over your nose and mouth
Keeping 6-feet distance from other residents and staff (when possible)

Ask other individuals (including staff) to avoid touching you with handshakes, hugs or kisses. Ask them to wash their hands. Do not be shy! It’s okay to remind people.
Watch out for potential scammers during this crisis.
If you begin to experience difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell, tell a staff member immediately.

Latest COVID-19 News

Share Your COVID-19 Honors Program Ceremonies!	https://www.ahcancal.org/News-and-Communications/Blog/Pages/Share-Your-COVID-19-Honors-Program-Ceremonies!-.aspx	Share Your COVID-19 Honors Program Ceremonies!	1/19/2022 5:00:00 AM	<p></p><div>Since the March launch of the COVID-19 Honors Program, AHCA/NCAL has received countless emails detailing the bravery and resilience of staff members and ways in which they’ve gone above and beyond to provide care. <br></div><div><br></div><div>Tell us how you have honored your amazing staff. Share photos and videos of your COVID Honors ceremonies on AHCA/NCAL’s <a href="https://www.facebook.com/ahcancal" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">Facebook page</a> with the hashtag #COVIDHonors. </div><div><br></div><div>Planning to honor your staff in 2022? Place your COVID Honors Program order now <a href="https://www.ahcapublications.org/products.asp?dept=39" data-feathr-click-track="true" target="_blank" style="text-decoration:underline;">via the AHCA/NCAL Bookstore</a>. <br></div><p></p>	Since the March launch of the COVID-19 Honors Program, AHCA/NCAL has received countless emails detailing the bravery and resilience of staff members and ways in which they’ve gone above and beyond to provide care.
CMS QSO Memos to Enforce Vaccine Mandate in 49 States and District of Columbia	https://www.ahcancal.org/News-and-Communications/Blog/Pages/CMS-QSO-Memos-to-Enforce-Vaccine-Mandate-in-49-States-and-District-of-Columbia.aspx	CMS QSO Memos to Enforce Vaccine Mandate in 49 States and District of Columbia	1/18/2022 5:00:00 AM	<div><span style="font-size:14.6667px;">The U.S. Supreme Court has stayed the preliminary injunctions against enforcement of the Centers for Medicare and Medicaid Services (CMS) interim final rule. This means CMS can enforce its vaccine mandate in states previously exempted due to the stay, with the exception of Texas. </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">CMS has released two QSO memos with separate deadlines for implementation. All other provisions are the same. </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><ul><li><span style="font-size:14.6667px;">The <a href="https://www.cms.gov/files/document/qso-22-07-all-attachment-ltc.pdf" data-feathr-click-track="true" target="_blank">December 28, 2021 QSO Memo</a> applies to California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia, Washington and Wisconsin. </span></li><li><span style="font-size:14.6667px;"></span>The <a href="https://www.cms.gov/files/document/attachment-ltc.pdf" data-feathr-click-track="true" target="_blank">January 15, 2022 QSO Memo</a> applies to providers in the following states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming. <br></li></ul></div><div><span style="font-size:14.6667px;"><strong>*Important note: The guidance in this enforcement does not apply to Texas as of January 17, 2022.</strong></span></div><div><span style="font-size:14.6667px;"><br></span></div><div><div><span style="font-size:14.6667px;">CMS establishes the same requirements in both memos but offers separate compliance deadlines starting 30 days from the issuance of either memo. AHCA/NCAL has highlighted key points below, but providers in the above states are <span style="text-decoration:underline;">strongly encouraged to review the applicable QSO memo in full</span>.  </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">AHCA/NCAL is hosting a <a href="https://educate.ahcancal.org/products/implementing-the-cms-vaccine-mandate" data-feathr-click-track="true" target="_blank"><strong>webinar</strong></a><strong> </strong><strong>TODAY, January 18 at 5 PM ET</strong> to review nationwide implementation. The Association will review implementation deadlines, which employees are covered, required record keeping, and other aspects of implementing the IFR. </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;"><strong>KEY HIGHLIGHTS</strong> </span></div><div><br></div><div><div><span style="font-size:14.6667px;"><strong><em>Which staff fall under the rule? </em></strong> </span></div><div><span style="font-size:14.6667px;">Staff refers to all individuals providing any care or services for the facility and its residents, whether under contract or arrangement. The only individuals this does not apply to are individuals who telework full time or who provide services entirely remotely.  </span></div><div><span style="font-size:14.6667px;"> </span></div><div><span style="font-size:14.6667px;"><strong><em>When are facilities in the states listed above required to be in compliance</em></strong><strong><em>?</em></strong>  </span></div><div><span style="font-size:14.6667px;">CMS implementation will be phased in as follows, depending on state. See map above and list to determine which applies for your facility. </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><ul><li><strong>January 27 or February 14, 2022</strong> for the first dose for two dose regime (i.e., mRNA Pfizer or Moderna) or J&J if electing to receive the J&J, which includes:  </li><ul><li>Policies and procedures developed and implemented (<a href="/Survey-Regulatory-Legal/Emergency-Preparedness/Documents/COVID19/Template-Vaccine-Policy-Procedures.docx" data-feathr-click-track="true" target="_blank">template policies and procedures</a> are available on the <a href="/Survey-Regulatory-Legal/Emergency-Preparedness/Pages/Coronavirus.aspx" data-feathr-click-track="true" target="_blank">AHCA/NCAL COVID-19 website</a> under 'Vaccines').  </li><li>100 percent of staff having received one dose of vaccine, except those with or pending an exemption request and those having a temporary delay recommended by the CDC.  </li><li>A facility above 80 percent and has a plan to achieve a 100 percent staff vaccination rate within 60 days would not be subject to enforcement action (e.g., civil monetary penalties [CMPs]).  <br></li></ul><li><span style="font-size:11pt;"><strong>February 28 or March 15, 2022</strong> for the second dose for two dose regime, which includes:  </span></li><ul><li>Policies and procedures developed and implemented.  </li><li>100 percent of staff having completed the vaccine series, except those with granted exemption request and those having a temporary delay recommended by the CDC.  </li><li>A facility above 90 percent and has a plan to achieve a 100 percent staff vaccination rate within 30 days would not be subject to enforcement action (e.g., CMPs).  </li></ul></ul></div><div><span style="font-size:14.6667px;"></span><strong><em>How will compliance be determined?</em></strong>  <br></div><div><span style="font-size:14.6667px;">Compliance will be determined through the regular survey process, including through standard and complaint visits and vaccination rates will be calculated from facility records and will take exemptions into consideration. Facilities are expected to track vaccination status, including booster status for each staff person and any exemptions, using a tracking tool of their choice. A facility’s tracking mechanism should clearly identify each staff member’s role, assigned work area, and how they interact with residents. Survey teams will also ask for information on how unvaccinated staff are assigned and additional precautions taken to prevent transmission. CMS will provide a specific tool for facilities to use at the time of the survey. </span></div><div><span style="font-size:14.6667px;"> </span></div><div><span style="font-size:14.6667px;"><strong><em>How will citations, including scope and severity, be determined?</em></strong>  </span></div><div><span style="font-size:14.6667px;">Facilities found out of compliance (less 100 percent of staff vaccinated, not including those with valid exemptions) will receive a citation with scope and severity based on staff vaccination rates, number of COVID-19 cases, policy and procedure implementation, and infection control practices.  </span></div><div><span style="font-size:14.6667px;"> </span></div><div><span style="font-size:14.6667px;">In the <a href="https://www.cms.gov/files/document/attachment-ltc.pdf" data-feathr-click-track="true" target="_blank">QSO memo</a>, CMS provides detailed guidance on scope and severity and a scope and severity grid on page 14.   </span></div><div><span style="font-size:14.6667px;"> </span></div><div><span style="font-size:14.6667px;"><strong><em>Do unvaccinated staff need to follow any special precautions?</em></strong>  </span></div><div><span style="font-size:14.6667px;">Yes, staff who are not yet fully vaccinated regardless of the reason must adhere to additional precautions that are intended to mitigate the spread of COVID-19. There are a variety of actions or job modifications a facility can implement to potentially reduce the risk of COVID-19 transmission including but not limited to:  </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><ul><li><span style="font-size:14.6667px;">Reassign unvaccinated staff to non-patient areas and duties.  </span></li><li>Require staff who have not completed their primary vaccination series to follow additional <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html" data-feathr-click-track="true" target="_blank">CDC-recommended precautions</a>, such as adhering to universal source control and physical distancing measures even if the facility is located in a county with low-to-moderate community COVID transmission. Although OSHA’s vaccine mandate is not in effect, there are additional  <a href="https://www.osha.gov/coronavirus/ets" data-feathr-click-track="true" target="_blank">OSHA-required measures</a> which should also be followed.  </li><li>Require at least weekly testing.  </li><li>Require use of a NIOSH-approved N95 or equivalent or higher-level respirator for source control, regardless of whether they are providing direct care to or otherwise interacting with patients.  <br></li></ul></div><div><span style="font-size:11pt;">AHCA/NCAL interprets this to mean providers must follow at least one of these stated precautions, or at least one other reasonable precaution not stated on this list. However, we are seeking clarity from CMS on whether this interpretation is correct and will communicate the response with members. This language is the same language CMS uses for other providers (e.g., hospitals) that are covered by this regulation. </span><br></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;"><a href="https://educate.ahcancal.org/products/cmss-staff-vaccine-mandate-implementing-religious-medical-exemptions" data-feathr-click-track="true" target="_blank">Previous AHCA/NCAL webinars</a> provided detailed information on how to implement medical and religious exemptions. <a href="https://educate.ahcancal.org/products/implementing-the-cms-vaccine-mandate" data-feathr-click-track="true" target="_blank"><strong>Registration</strong></a><strong> is open for the Tuesday, January 18 webinar on nationwide implementation of this IFR</strong><strong>.</strong>   </span></div><div><span style="font-size:14.6667px;"> </span></div><div><span style="font-size:14.6667px;">Additional information is available on <a href="https://educate.ahcancal.org/" data-feathr-click-track="true" target="_blank">ahcancalED</a> and <a href="http://getvaccinated.us/" data-feathr-click-track="true" target="_blank">#GetVaccinated</a>. Please contact <a href="mailto:COVID19@ahca.org" data-feathr-click-track="true" target="_blank">COVID-19@ahca.org</a> with any questions. </span><span style="font-size:11pt;"></span></div></div></div>	SCOTUS has stayed the preliminary injunctions against enforcement of the CMS interim final rule. This means CMS can enforce its vaccine mandate in states previously exempted due to the stay, with the exception of Texas.
Updated CMS FAQ and Visitation Infographic Now Available	https://www.ahcancal.org/News-and-Communications/Blog/Pages/Updated-CMS-FAQ-and-Visitation-Infographic-Now-Available.aspx	Updated CMS FAQ and Visitation Infographic Now Available	1/18/2022 5:00:00 AM	<p></p><div><span style="font-size:14.6667px;">The Centers for Medicare and Medicaid Services (CMS) has updated the <a href="https://www.cms.gov/files/document/nursing-home-visitation-faq-1223.pdf" data-feathr-click-track="true" target="_blank">Nursing Home Visitation Frequently Asked Questions (FAQ)</a> to provide clarification to <a href="https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf" data-feathr-click-track="true" target="_blank">recent visitation guidance</a>. The FAQ highlights that states may instruct nursing homes to take additional measures to make visitation safer, while ensuring visitation can still occur. This includes requiring that during visits, residents and visitors wear masks that are well-fitting and preferably those with better protection, such as surgical masks or KN95. </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">CMS also released an <a href="https://www.cms.gov/files/document/how-safely-visit-nursing-homes.pdf" data-feathr-click-track="true" target="_blank">infographic</a> on how to safely conduct visits to nursing homes. This infographic may be helpful to use when educating families and visitors and for posting in the facility. </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">See the <a href="https://www.cms.gov/nursing-homes" data-feathr-click-track="true" target="_blank">CMS Nursing Home Resource Center</a> for additional information. </span><span style="font-size:11pt;"></span></div>	CMS has updated the Nursing Home Visitation Frequently Asked Questions (FAQ) to provide clarification to recent visitation guidance.
Public Health Emergency Extended	https://www.ahcancal.org/News-and-Communications/Blog/Pages/Public-Health-Emergency-Extended-Jan-2022.aspx	Public Health Emergency Extended	1/14/2022 5:00:00 AM	<p>Today, U.S. Health and Human Services Secretary Xavier Becerra renewed the <a href="https://aspr.hhs.gov/legal/PHE/Pages/COVID19-14Jan2022.aspx" data-feathr-click-track="true">declaration </a>that a public health emergency exists. This is effective January 16, 2022 and will continue for 90 days pursuant to federal law. <br></p><div><span style="font-size:14.6667px;">PHE renewal through mid-April is welcome news. It provides for the uninterrupted continuation of several flexibilities that have protected beneficiary access to important services in as safe and effective manner as possible. With this renewal:<br><br></span></div><div><ul><li><span style="font-size:14.6667px;">Enhanced FMAP to states (6.2%) is extended to at least June 30, 2022, and will be further if the PHE is extended again in April. The increased FMAP ends in the calendar year quarter in which the PHE ends;</span></li><li><span style="font-size:14.6667px;">All 1135 waivers will continue including </span></li><ul><li><span style="font-size:14.6667px;">Temporary nurse aide </span></li><li><span style="font-size:14.6667px;">Waiver of required three day hospital state to access skilled nursing benefits</span></li><li><span style="font-size:14.6667px;">Spell of Illness</span></li></ul><li><span style="font-size:14.6667px;">All state Medicaid flexibilities will continue including</span></li><ul><li><span style="font-size:14.6667px;">Expedited state plan amendment review</span></li><li><span style="font-size:14.6667px;">Waiver of Medicaid redetermination requirements</span></li></ul></ul></div><div><br><br></div><p></p>

Guidance & Resources

By Source

AHCA/NCAL

Guidance

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How to Prevent and Manage Outbreaks
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Admissions from and Discharges to Hospitals
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Communal Dining
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Hospice Services
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Where to Ask for Help

Emergency Preparedness

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Template After-Action Report / Improvement Plan
Members can use this template to document their response and recovery efforts during the pandemic in order to meet Emergency Preparedness requirements from CMS

Screening

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Screening Checklists for Visitors & Personnel (.zip)
English and Spanish versions

Confirmed Cases

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Cohorting Residents
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Nebulizer Treatment for COVID-19 Infected Residents with Severe Respiratory Symptoms
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COVID-19 Nursing Home Dashboard

Residents

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Keeping Residents Engaged
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Offering Compassionate Care
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Alzheimer's Association: Caring for Persons Living with Dementia in a Long-Term or Community-Based Care Setting During COVID-19

CDC

Overview of COVID-19

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Coronavirus (COVID-19)
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FAQs

Prevention Resources

Reporting Resources

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LTCF COVID-19 Module
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Evaluating and Reporting Persons Under Investigation (PUI)

Health Care Facility Resources

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Resources for Health Care Facilities
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Health Care Infection Control Guidelines
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Clinical Care Guidance
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Clinician Outreach and Communication Activity (COCA) Calls & Webinars
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Disposition of Non-Hospitalized Patients with COVID-19
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Criteria for Return to Work for Healthcare Personnel

Communication Resources

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CDC's Crisis and Emergency Risk Communication (CERC)
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CERC in an Infectious Disease Outbreak

CMS

Memos & Guidance

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LTC Facility Testing Requirements and Revised COVID19 Focused Survey Tool
QSO Memo 20-38 revised April 27, 2021
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Updating Requirements for Reporting of SARS-CoV-2 Test Results by Clinical Laboratory Improvement Amendments of 1988 (CLIA) Laboratories
QSO Memo 20-37-CLIA, NH issued August 26, 2020
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Requirements for Notification of COVID-19 Cases Among Residents and Staff in Nursing Homes
CMS is requiring nursing homes to report COVID-19 facility data to the CDC and to residents, their representatives, and families of residents. This memo also includes updated survey tools and a FAQ on new reporting requirements.
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Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes
Guidance on: screening visitors and who should be restricted; screening employees and contractors and who should be asked to stay at home; when patients should be managed in the facility vs sent to the hospital; what to do when transferring residents with suspected COVID-19, and; what criteria to use in accepting patients from the hospital with COVID-19.
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Prioritization of Survey Activities
Announces that CMS will re-prioritize surveys to conduct focus surveys about infection control for facilities that have had an infection control deficiency in the past to assure that they are in compliance with the new regulations.
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Guidance for Infection Control and Prevention Concerning Coronavirus Disease (COVID-19): FAQs and Considerations for Patient Triage, Placement and Hospital Discharge
Guidance to hospitals on screening visitors, employees and when to admit and discharge residents.
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Nursing Home Visitation
Revised April 27, 2021 - The guidance provides reasonable ways a nursing home can safely facilitate in-person visitation to address the psychosocial needs of residents.
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Interim Final Rule - COVID-19 Vaccine Immunization Requirements for Residents and Staff
This includes new requirements for educating residents or resident representatives and staff regarding the benefits and potential side effects associated with the COVID-19 vaccine, and offering the vaccine. Furthermore, LTC facilities must report COVID-19 vaccine and therapeutics treatment information to NHSN.

Resources

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COVID-19 Focused Survey for Nursing Homes
A zip file from CMS with updated survey forms in the COVID-19 Focused Survey subfolder. Providers should use the revised “COVID-19 Focused Survey for Nursing Homes” to perform their self-assessment.
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1135 Waiver Request (AHCA Template)
Providers unable to meet certain federal requirements due to COVID-19 should file an individual 1135 waiver for flexibility with regulations that cannot be met due to shortages in capacity or resources such as staffing or that conflict with other guidance, needs, and expectations during the pandemic.
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Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit

Other Federal Agencies

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AHRQ's Nursing Home COVID-19 Action Network
The Agency for Healthcare Research and Quality (AHRQ) has compiled resources that address staff and resident well-being and safe operations in nursing homes and long term care facilities.
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EPA: Registered Disinfectant Products
Coronaviruses are enveloped viruses, meaning they are one of the easiest types of viruses to kill with the appropriate disinfectant product.
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Occupational Safety and Health Administration (OSHA) Standards for COVID-19
OSHA recordkeeping requirements at 29 CFR Part 1904 mandate covered employers record certain work-related injuries and illnesses on their OSHA 300 log. While 29 CFR 1904.5(b)(2)(viii) exempts recording of the common cold and flu, COVID-19 is a recordable illness when a worker is infected on the job.

State & Local

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Find Your Local Health Department
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Find Your State Health Department

Guidance & Resources

By Topic

Finance & Reimbursement

General

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Grant & Loan Management Primer
AHCA/NCAL has developed a basic primer for organizing oversight and day-to-day management of various federal grants and loans.
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COVID-19 Related Loss and Cost Calculator
This excel workbook allows members to assess allowable costs already reimbursed by pre-COVID-19 payers (Medicare and Medicaid) and compare such reimbursement to shortfalls where grants and loans fill funding gaps.

CARES Act Provider Relief Fund