Deepening our understanding of immunity and COVID-19 spread: Your WellSky COVID-19 Briefing
In this edition
Use the links listed below to jump between sections.
NEWS
Current cases & maps
Stimulus debate continues with little action
Nursing home deaths are rising
CARES Act funds are coming to nursing homes
Outpatient Perspective Payment System: The proposed 2021 rule
Telehealth executive order
COMPLIANCE
CMS releases new OASIS guidance
Extension of ABN adoption
Proposed outpatient therapy cuts
New legislation on hospice respite relief is considered
Paycheck Protection Program
CLINICAL
Cancer diagnoses fell sharply during early days of the pandemic
Deepening our understanding of immunity and COVID-19’s spread
Latinx and Black children with COVID-19 have higher hospitalization risk
ADMINISTRATIVE
Current cases & maps
This week, we can see evidence of noticeable improvements in the COVID-19 statistics. It is true that the U.S. passed 5 million COVID-19 cases last week, and it is also true that the last million cases were added in just 17 days. We still account for a quarter of the cases worldwide. Mortalities have also increased in states that were the focus of earlier concerns but where seven–day new case averages are now declining. This seems to be the trend — cases go up, deaths don’t catch up for a couple of weeks and then as cases start to go down, mortalities rise and then, finally, level off. The numbers that we see this week are anything but pretty, but we can be encouraged that things are improving, albeit very slowly.
Our weekly view of the Centers for Disease Control and Prevention (CDC) map (below) is one indicator of the better news we’re seeing at this time. There are no additional states that have reached the top tier of 40,000 or more cases in this week’s map.
The New York Times case map (below) clearly shows the downturn in the overall seven-day averages of new cases reported.
Mortalities are still high, but they are beginning to drop, as 18 states have started to post declining numbers of new cases — including Alabama, Alaska, Arizona, California, Colorado, Delaware, Florida, Louisiana, Maine, Nevada, New Hampshire, North Carolina, New Mexico, Pennsylvania, South Carolina, Utah, Vermont, and Wyoming. Many of those states were listed as simmering hotspots just two weeks ago.
In terms of negative trends, and listed in order of severity, cases are rising again in Illinois, Virginia, Hawaii, South Dakota, Rhode Island, and Massachusetts.
According to data compiled by the New York Times, trends are essentially unchanged in Georgia, Texas, Idaho, Arkansas, Tennessee, Oklahoma, North Dakota, Missouri, Iowa, Wisconsin, Kentucky, Indiana, Kansas, Nebraska, Minnesota, Maryland, Montana, Ohio, Washington, Oregon, Michigan, West Virginia, New Jersey, New York, Connecticut, and the District of Columbia.
Here is where the U.S. stands this week:
- Over the past week, cases increased an average of more than 53,000 per day exceeding a total of 5 million by Sunday, August 9
- Mortalities reached 162,000 – an increase of 8,000 in the last week and roughly 1,000 deaths per day
COVID Exit Strategy added a new table with an overall, color-coded assessment of how each state is doing based on a variety of measures:
- 14-day case growth trends
- Testing percentages based on targets
- New cases per million per day
- Whether contact tracing is possible
- COVID-19 infection rates
As with the other maps provided on this site, green indicates a positive trend, yellow is a cautionary indicator, and red suggests a negative trend — with the deepest red color indicating the most adverse trend. A total of 18 states have cumulative indicators putting them in the most serious category.
Click the snippet below to see the complete table at covidexitstrategy.org.
Using data from the Department of Health and Human Services (HHS), the website also measures hospital capacity based on statistics reported as of Thursday, August 6. There is still a lot of pinkish-red on this map (below), indicating that we aren’t out of the woods just yet.
Other important events and trends from the week:
- Becker’s Healthcare reports that some U.S. businesses, including some healthcare entities, are “unfiling” for bankruptcy in order to access COVID-19 relief funds, especially Paycheck Protection Program (PPP) loans. The action usually comes as a result of a request on the part of the bankruptcy petitioner to have the court dismiss the case, thus reopening once-closed avenues for financial relief.
- The CDC has issued another warning about ingesting hand sanitizer, following four deaths related to methanol poisoning. The article notes that 15 incidents involving hand sanitizer ingestion were reported in Arizona and New Mexico during May and June. In addition to the four deaths, three people were discharged with vision loss, four people remain hospitalized, and four people were discharged with complications. The illustrative case is that of a 44-year-old man who drank an unknown quantity of hand sanitizer. His clinical course was complicated by seizures, and he required hemodialysis during a six-day hospital stay, after which he was discharged with “near-total vision loss.”
- Several large cities continue to grapple with the issue of whether and/or how to open schools as parental and student anxiety mounts. In New York, after a protracted shutdown, schools will reopen. However, in Chicago, where case counts are again rising, schools will begin the fall semester with online–only instruction. The same strategy has been adopted in Los Angeles and San Diego. In Florida, schools have been directed to open for classroom instruction, unless there is a local mandate that prohibits doing so. In some states, like Indiana, infections are being detected and schools are temporarily shutting down for cleaning and disinfection. For some parents, including those who work in post-acute healthcare, to the fall semester may prove to be challenging.
- The mayor of Los Angeles Eric Garcetti has come up with an inventive strategy to enforce social distancing guidelines. He has threatened that, if first responders are called to the scene of a large party in the city and they determine a prohibited gathering is occurring, power and water for the property could be shut off. It is a novel way to shorten a party.
- Some areas are diligently pursuing their limits on who can visit and whether they must self-quarantine after arriving. Chicago has imposed limits on travelers from Alabama, Arkansas, California, Florida, Georgia, Idaho, Iowa, Kansas, Louisiana, Mississippi, North Carolina, Nevada, Oklahoma, South Carolina, Tennessee, Texas, and Utah. Kansas has imposed travel restrictions on most of the same states and Alaska now requires proof of a negative COVID-19 test within 72 hours prior to arrival. New York, New Jersey, and Connecticut have formed a coalition aimed at screening visitors with New York sheriffs establishing checkpoints to ensure compliance with a self-quarantining directive.
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News
Stimulus debate continues with little action
Last week, Congress was unable to coalesce around a stimulus package acceptable to both the Republicans and Democrats, so the Trump administration stepped in on Saturday, August 8, with an executive order and three memoranda designed to address needed relief. Unfortunately, many of the things that healthcare providers are looking for are not in the mix, and the substance of the directives is a bit different than initially publicized. There is also the issue of whether the administration has overstepped its legal bounds. I’ll leave that analysis to the lawyers. In the meantime, here is the essence of what was ordered:
- Unemployment benefits would be extended for up to $400 per week using $44 billion in previously approved disaster aid that has not yet been spent. The catch is that states would have to supply 25% of the benefit or $100 a week for every person covered. Later, apparently as a response to push back from the states, the administration seemed to suggest that states could apply for the federal government to cover the entire $400. Decisions would be made on a state-by-state basis.
- In a separate memorandum, the administration directed the U.S. Department of Treasury to halt collection of employee Social Security and Medicare taxes starting September 1 through the end of 2020 for workers who earn less than $4,000 every two weeks. Doing the math, that would be everyone making less than about $104,000 a year. This one has a catch, too. For a few weeks, workers will have larger checks due to the tax deferral, but the taxes will still be due later.
- The single executive order calls on HHS and the CDC to consider whether an eviction ban is warranted. The prior ban expired on July 24 and it is widely believed that as many as 40 million renters could be in danger of being evicted in coming months. Unfortunately, the order does not promise relief, but it does also direct the secretaries of U.S. Department of Treasury and Department of Housing and Urban Development (HUD) to determine whether additional funding may be available to forestall looming evictions.
- Student loan payments would be deferred until December 31 when principal payments would again be due. This, too, is the subject of a memorandum which waives interest on student loans held by the federal government through the end of the year.
For healthcare providers looking for additional relief, there are several expectations that could fall by the wayside unless Congress is able to come together, among them some relief around the repayment schedules associated with the Accelerated Advance Payments. For many post-acute providers, the repayment via recoupment has already begun.
In addition to unemployment relief and additional provider funds is the issue of worker testing to ensure that the workforce remains uninfected. According to federal and some state guidelines, insurers are not necessarily obligated to pay for COVID-19 testing as a determinant of fitness for work any more than they would be required to pay for other types of employment testing, such as drug screens. They are required to cover testing ordered by a physician or other provider related to diagnosing or treating a patient who has been in contact with an infected person. This raises another unforeseen expense for many small businesses, including post-acute providers who must ensure staff safety and fitness to see patients. Several trade groups have requested federal resources to pay for testing which is another anticipated feature of an additional stimulus package.
Nursing home deaths are rising
The Wall Street Journal reported on August 8 that nursing home mortalities from COVID-19 have begun to rise again — with over 1,000 deaths in the week that ended July 26, based on the most recently available data. Nursing home deaths spiked significantly in Florida and Texas between May 31 and July 26. Meanwhile, nursing home deaths receded even more dramatically in New York and New Jersey over that same period. The moral of the story seems to be that, when there are hotspots, nursing home residents bear the brunt of the mortality trends.
Overall, across the entire country, deaths in nursing homes and assisted living facilities (ALFs) have risen more slowly, as shown in the graph below.
Based on the data analysis, the Wall Street Journal attributes more than 65,000 COVID-19 deaths to residential facilities since the beginning of the public health emergency, representing about 40% of all mortalities from the virus.
CARES Act funds are coming to nursing homes
Last Friday, August 7, HHS announced details of the next Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Fund distributions to nursing homes. The disbursement will amount to about $5 billion in total and will be designated for use in protecting nursing home residents from the impact of COVID-19. It will come in two parts:
- First, there will be about $2.5 billion in up-front funding to support testing, staffing needs, and acquisition of personal protective equipment (PPE). Funding will also be made available for those facilities establishing isolation units.
- The other half of the funding will be tied to nursing home performance. The performance evaluation will consider the prevalence of the virus in the local area and will be based on the facility’s ability “within this context to minimize COVID spread and COVID-related fatalities among residents.”
Outpatient Prospective Payment System: The proposed 2021 rule
On August 4, the Centers for Medicare & Medicaid Services (CMS) released the proposed 2021 outpatient rule.
The key takeaway for post-acute providers is the proposal to eliminate the Inpatient Only List (IPO) over a three-year period, beginning with the removal of 300 musculoskeletal services. The rule continues a two-year exemption from Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) referrals to recovery auditors related to patient status and place of service starting in January 2021.
The proposed rule includes adding 11 procedures, including total hip replacements, to the list of services that may be performed in an ambulatory surgical center (ASC). This simply parallels the process that we’ve seen in recent years related to other procedures that commonly produce home health referrals including total knee replacements which were first moved to outpatient status and then to ASCs last year. As I have said to many home health providers, we need to realize that CMS is pushing care down to the lowest level of intensity and this will portend many more “community” than “institutional” admissions in the future. Thus, as home health providers experienced revenue drops due to COVID-19, those losses may not be entirely recoverable over the long term, given the proposed outpatient rule changes.
Telehealth executive order
Last week, I reported on the Administration’s issuance of an executive order calling for HHS to make the telehealth flexibilities arising from the public health emergency permanent. Seema Verma, the administrator of CMS, partially punted the ball to Congress noting that removal of restrictions on the site of care, determination of eligible providers (including post-acute providers) and lifting of restrictions enabling telehealth services only in rural areas must come from the legislative branch before CMS can get very far with changes.
More immediately and within its realm of authority, CMS is proposing changes to the Physician Fee Schedule that would remove the 30-day limit on virtual nursing facility visits and establish a three–day interval. A fact sheet notes that nursing home discharge visits would also be allowed via telehealth.
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Compliance highlights
CMS releases new OASIS guidance
I finally got to read the entirety of the July 2020 CMS Quarterly OASIS Q&A document, which is partially devoted to OASIS guidance about the continuing public health emergency, with a notation that it is retroactive to March 1, 2020. Here are two key takeaways related to the public health emergency — one related to a refused discharge visit for purposes of completing the final assessment and the second related to completion of a discharge assessment via a telephone encounter.
QUESTION: The last registered nurse in-person visit was on April 1. Physical therapy completed an in-person discipline discharge on April 7. The registered nurse continued to monitor the patient via telehealth visits through April 15. During the April 15 telehealth visit, the patient expressed his/her wish to be discharged from home health services and declined an in-person visit to complete the discharge OASIS.
Would the physical therapist complete the discharge comprehensive assessment with OASIS since they completed the last in-person visit, or would the registered nurse complete the discharge comprehensive assessment with OASIS based on the last telehealth visit?
If the physical therapist completes the discharge OASIS, can information from the last telehealth visit and any telehealth visit made in the four days prior be used to complete the discharge OASIS? Or does this guidance apply only to in-person visits?
ANSWER: Based on the CMS Interim Final Rule [CMS-5531-IFC] announced on April 30, 2020, agencies have the flexibility, in addition to remote patient monitoring, to use various types of technology during the PHE. As per the Home Health Agencies: CMS Flexibilities to Fight COVID-19, agencies can provide more services to beneficiaries using telecommunications technology within the 30-day period of care, so long as it’s part of the patient’s plan of care and does not replace needed in-person visits as ordered on the plan of care. The nurse that performed the 4/15 Telehealth encounter could complete the discharge comprehensive assessment with OASIS using information collected at the 4/15 encounter and may use additional information available from other staff, from 4/15 plus the four preceding days.
QUESTION: Can I complete a discharge OASIS via an audio-only telehealth encounter?
ANSWER: Based on the CMS Interim Final Rule [CMS-5531-IFC] announced on April 30, 2020, HHAs have the flexibility, in addition to remote patient monitoring, to use various types of technology. As per Home Health Agencies: CMS Flexibilities to Fight COVID-19 (https://www.cms.gov/):
Telecommunications technology can include, for example: remote patient monitoring; telephone calls (audio only and TTY); and 2-way audio-video technology that allows for real-time interaction between the clinician and patient. However, only in-person visits can be reported on the home health claim. Providers are expected to determine if the patient’s needs and the requirements of the Conditions of Participation can be met using telehealth encounter(s). Providers will also have to consider the technical capabilities of the agency and of the patient using telehealth encounter(s). Therefore, when the telehealth encounter is used to deliver care, the telehealth encounter reflects the agency’s determination that the patient’s needs related to completion of the Discharge Comprehensive Assessment including OASIS may be completed using audio-only telecommunications technology.
Extension of ABN adoption
As we reported previously, CMS has issued a new Advanced Beneficiary Notice (ABN) form — CMS-R-131 — for use through June 2023. Originally, its use was mandated as of August 31. However, the deadline has now been pushed to January 1, 2021. The form and instructions can be found here.
Proposed outpatient therapy cuts
Last week, we learned that CMS is proposing a 9% reduction in outpatient Medicare rates for some therapy services. The reduction comes with the CY 2021 Medicare Physician Fee Schedule Proposed Rule, which was released last week. The plan calls for a decrease to apply to physical and occupational therapy treatments provided on an outpatient basis. Patients who have exhausted their Part A inpatient benefits often receive therapy services under Part B. If finalized, the proposal also would allow therapy assistants to provide maintenance therapy, which is currently allowed only under an §1135 waiver. The National Association for the Support of Long-Term Care (NASL) has asked for postponement of the cuts. The proposed rule is out for comments, and we’ll report later in the fall on what is actually finalized.
New legislation on hospice respite relief is considered
Last week, Senators Sherrod Brown of Ohio and Shelley Moore Capito of West Virginia introduced the COVID-19 Hospice Respite Care Relief Act of 2020 which would, if enacted, create additional flexibility for respite care services provided by hospices. The legislation would provide authority to the secretary of HHS to waive the five-day maximum for respite care if a patient’s caregiver is unable to provide care due to illness for up to 15 days. This also includes authority to waive the requirement that respite care be provided only in an inpatient facility such that respite care could become available at home.
According to the National Association for Home Care & Hospice (NAHC), which supports the legislation, the “impetus for the legislation relates to challenges experienced by hospices nationwide during the COVID-19 pandemic arising from the need for extended respite in situations where family caregivers are not available to care for hospice patients for a time frame exceeding the current five-day limit.” You can read the full fact sheet from NAHC here.
Paycheck Protection Program
Another set of updated FAQs regarding PPP came out last week. While the program officially closed for loan applications as of August 8 — even with funds still unused — many questions remain. Here are some highlights of the newly released, 10-page FAQ document:
- Borrowers have 10 months after the eight-week or 24-week period during which funds can be used to submit the application for loan forgiveness. This raises a question as to whether a borrower must make payments on the loan if forgiveness paperwork, filed timely, has not generated a response from the lender. The answer is no. Repayment does not start until the loan forgiveness application has been reviewed and acted upon by the lender.
- For calculating cash compensation, the gross amount of an employee’s wages before deductions for taxes and employee benefits should be used.
- Payroll costs incurred during the covered period but paid after the period ends are forgivable. Likewise, payroll costs incurred prior to the start of the covered period and paid during the covered period are also forgivable. Bonuses and hazard pay are forgivable expenses for employees if the $100,000 annual threshold is not exceeded by the payments.
- Employer expenses for group healthcare paid or incurred during the covered period are forgivable. However, the employee–paid portion (generally deducted by the employer from an employee’s check) is not forgivable because it is not the employer’s expense.
- Retirement plan contributions are considered payroll costs, once again as if employee contributions are omitted from the declared expense.
- Business mortgage interest on real or personal property can be forgiven along with business utility costs. Previously, we wondered if transportation costs would include mileage paid to employees who visit patients. The answer is, apparently not, as this refers to transportation utility fees assessed by state and local governments. These fees are eligible for forgiveness even though mileage costs are not.
- The section on loan forgiveness reductions reiterated a few policies we’ve already known about — for example, that employers will not be penalized for a reduction in full-time equivalent (FTE) employees if the borrower offered to rehire such employee(s) and the employee(s) declined to return to work.
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Clinical highlights
Cancer diagnoses fell sharply during early days of the pandemic
A new article published in JAMA Network Open last week reports that fewer cancers were being diagnosed in the early days of the public health emergency due to patients simply foregoing physician visits and diagnostic procedures. The article points to a steep decline in new cases of six different types of cancers, based on information from Quest Diagnostics.
During the seven weeks from March 1 through mid-April 2020, the mean percentage of newly diagnosed cancer patients dropped by more than 46% for breast, colorectal, lung, gastric, pancreatic, and esophageal cancer. The most significant decline was in breast cancer diagnoses — the smallest decline was in pancreatic cancers. Interestingly, three quarters of the patients measured during the baseline and pandemic periods were women with an average age of 66. Some have indicated that the delays in cancer diagnoses could have an effect that could add 10,000 extra deaths in the next ten years related to breast and colorectal cancers alone, which could equate to trading one public health crisis for another.
Deepening our understanding of immunity and COVID-19’s spread
According to a new study published by JAMA Internal Medicine, those with asymptomatic COVID-19 have the same viral loads as patients with symptoms, even though a higher proportion of those without symptoms may test negative a few weeks after their initial diagnosis. The research paper was written by an internal medicine researcher in South Korea and published last week.
Researchers assessed samples from just over 300 infected people between the ages of 22 and 36 who were treated at the same community center. About a third were free of symptoms when they went into isolation and 19% finally experienced symptoms between 14 and 20 days after their diagnosis. The others remained symptom-free for 20 to 26 days. Investigators noted that the viral loads were comparable between the cases that were considered to be asymptomatic and those that produced symptoms. Interestingly, after two weeks, almost 34% of the patients without symptoms tested negative, with the proportion of negative tests among this group growing to 75% three weeks after diagnosis.
The paper’s author noted that “it is possible that the asymptomatic patients in our cohort were not representative of all symptomatic patients in the community because false negatives would not have been included in our sample . . . and we did not determine the role that molecular viral shedding played in asymptomatic patients.”
In another study, we learned that about 40% of people with COVID-19 have no symptoms with new research — suggesting that some people may be partially protected from infection due to past histories of the common cold.
Researcher Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, noted that a high rate of asymptomatic infection “is a good thing” for the individual and for society. The article notes that with uneven transmission rates throughout the world and unusual numbers of people who are infected but without symptoms, it appears that as many as 40% of the people who have or have previously had the virus were or are asymptomatic.
When COVID-19 was first identified in December 2019, it was widely assumed that humans had no immunity from the virus. However, now there is some evidence to suggest that the initial assumption was incorrect. Recent studies have suggested that people with T-cells may have immunity that could come from childhood vaccinations or could trace back to “previous encounters with other coronaviruses, such as those that cause the common cold.” This could explain why some are able to fend off the illness and others are not able to do so.
Director of the National Institute of Allergy and Infectious Diseases (NIAID) Dr. Anthony Fauci has chimed in with his view that while the studies are being intensely scrutinized, it may be premature to come to conclusions just yet. He cautions that there are multiple reasons why some may seem to be more immune than others including youth and general health. He emphasizes that those who contract the disease, even with mild symptoms, may have lingering health issues. “There are many unknown factors that . . . determine why someone gets an asymptomatic infection. It’s a very difficult problem to pinpoint one thing.”
Latinx and Black Children with COVID-19 have higher hospitalization risk
As we think about kids going back to school in the coming weeks, a new Washington Post article points out that Latinx children are eight times more likely and Black children are five times more likely to be hospitalized when infected with COVID-19 than their White counterparts. According to the article, in the United States, 18% of the population identifies as Latinx —13% are Black.
The piece is based on a CDC report using data collected in 14 states — including California, Georgia, New York, and Ohio — between March 1 and July 25. It acknowledges that most cases in children are mild with low hospitalization rates overall but, like their adult counterparts, Black and Latinx children are still more likely to experience a severity of illness that could lead to hospitalization. While 164.5 adults per 100,000 were hospitalized with COVID-19 between March and July, the rate for children was only eight per 100,000 — with those under the age of two experiencing the highest hospitalization rates. Underlying conditions were common and about a third of pediatric patients ended up in the ICU, even though only about 6% required mechanical ventilation while there.
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Administrative highlights
Is Legionnaire’s disease making a comeback?
Late last week, we learned that the CDC has closed some of its offices in Atlanta due to concerns over the discovery of Legionella bacteria in the water system. Legionella bacteria build up in stagnant plumbing systems and causes Legionnaire’s disease, which can be fatal about 10% of the time. Warnings have been circulating about potential water quality concerns in establishments such as commercial buildings, hotels, and gyms that have been closed for lengthy periods of time. If your building might qualify as one that has been largely closed for a time, you may want to read the CDC’s guidance for eliminating contamination. Below, we’ve compiled some of the recommended steps to eradicate mold and Legionella.
- Five steps to minimize mold risk
- Maintain low indoor humidity not exceeding 50%.
- Before occupants return, assess the building for mold and excess moisture. Trained industrial hygienists can recognize dampness and mold by sight and odor. When dampness is detected, address the source of the water first, followed by clean up and remediation.
- When the mold assessment is negative or following remediation, the HVAC system should be operated for at least 48 to 72 hours before occupants return.
- Once the building is reopened, weekly checks of the HVAC system should be conducted to ensure operating efficiency.
- If no HVAC maintenance program is in place, one should be developed and implemented to include inspection and maintenance of HVAC systems, calibration of system controls, and testing/balancing of the system.
- Eight steps to minimize Legionella risk
- The building should have a water management system following CDC guidelines. CDC water management training should be conducted using CDC tools.
- Make sure that water heaters are properly maintained with correct temperature settings.
- Flush the water system.
- Clean all decorative water features, such as fountains.
- Ensure that hot tubs or spas, if there are any, are safe for use.
- Make sure cooling towers are clean and well-maintained.
- Make sure that sprinkler systems are maintained.
- Maintain the water system and ensure that disruptions to the water supply are addressed and mitigated.
Provider Relief Funds: New FAQs
We have new FAQs about the Provider Relief Funds, as well as new announcements from HHS released on August 10. The updated FAQ document is a 57-page read. We’ve also collected some of the key highlights below:
- Parent organizations that receive Provider Relief Funds on behalf of subsidiaries must remit the payments to the subsidiary(ies). Parent organizations that receive funds on behalf of subsidiaries are also precluded from reallocating the funds among those that may not be eligible for Provider Relief Funds.
- Reports on how providers used Provider Relief Funds must be submitted no later than July 31, 2021. HHS also expects that all funds will have been expended prior to or, at the latest, on that date. Future direction will be provided by HHS as to how providers should return unused portions of Provider Relief Funds. Earlier suggestions established an expectation that reporting guidance will be issued mid-month, and it is possible that instructions for return of unused funds may be included.
- Providers that receive more than $750,000 in funding must arrange for an audit based on federal guidance and audit standards. Audit due dates can be extended.
- Providers that received funding through the other disaster relief programs, such as the Paycheck Protection Program, are still eligible to receive payments related to Medicaid and Children’s Health Insurance Program (CHIP) distributions. These programs are mutually exclusive. Likewise, providers that only bill through Medicaid waiver programs are eligible to receive funds through the targeted distribution.
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In closing
Over the weekend, I watched a compelling short video from the Wall Street Journal about four crisis nurses who have been traveling from one COVID-19 hotspot to the next — starting in New York and recently ending with trips to Texas. Being a traveling nurse is not an easy occupation, even in the best of times, but the video drives home what we know about nurses — they go where they are needed and get the job done — although likely not without a few intense and scary moments. After you watch it, tell a nurse you know how much you appreciate them. The article and embedded video can be found here.
On a lighter note, we’ve all heard the stories about families getting puppies in record numbers during the pandemic. But did you also know that the animals at your local zoo may be missing you? The Wall Street Journal (WSJ) thinks so. You can read an article about the ways zookeepers are keeping meercats active at the Adelaide Zoo in Australia; Jax the mandrill’s lunches with his keeper that keep him engaged while people are away; and Row the cockatoo, who is missing visitors who usually help her finish a tune. Read the WSJ article here. It turns out that everybody needs a little diversion once in a while.
Finally, in my “word of the day” tradition, I bring you the day’s top definition from the Urban Dictionary — “coronacoaster” — which means that “when your emotions are on a rollercoaster due to all the news each day about the Coronavirus, you’re on a coronacoaster.” Indeed — I think I’ve been riding for a while now.
Be safe out there, and be well. As always, I salute each and every one of you! More next week.