Is the US finally winning against the pandemic?: Your COVID-19 Briefing
In this edition
Use the links listed below to jump between sections.
NEWS
CONNECT Act offers new telehealth options for home-based providers
New campaign aims for 70% vaccinated by July 7
Helping kids to cope with the aftermath of COVID-19
In-person meetings and conferences are back!
COMPLIANCE
CLINICAL
ADMINISTRATIVE
Please note
The views, information, and guidance in this resource are provided by the author and do not necessarily reflect those of WellSky. The content provided herein is intended for informational purposes only. The information may be incomplete, and WellSky undertakes no duty to update the information. It is shared with the understanding that WellSky is not rendering medical, legal, financial, accounting, or other professional advice. WellSky disclaims any and all liability to all third parties arising out of or related to this content. WellSky does not make any guarantees or warranties concerning the information contained in this resource. If expert assistance is required, please seek the services of an experienced, competent practitioner in the relevant field. WellSky resources are not substitutes for the official information sources on COVID-19. Providers should continue to track developments on official CMS and CDC pages, including:
CMS response to Coronavirus and latest program guidance
CDC interim infection prevention and control recommendations
Current Cases and Maps
As we begin the month of June and embark on a welcome summer season, the COVID-19 heat map from the New York Times is taking on a much lighter hue with very few noted hot spots across the country. As several have described the changes, in a few short weeks we have gone from awful to much better – a long-awaited realization. About 42% of all adult Americans have been vaccinated with over half (52%) having had at least one injection of a two-dose vaccine. New cases are dropping dramatically and now amount to fewer than 15,000 per day on average – a milestone we haven’t seen since a year ago. With a small sigh of relief, it is also true that we must still do everything we can to ensure that we avoid new outbreaks of the illness that has infected over 33 million people and caused more than 597,000 deaths in the United States alone. With new cases down 42% in the last two weeks and mortalities also down by 20% for the same period, we appear to be finally turning the corner. The objective now will be avoiding any unnecessary U-turns.
The graph below, depicting the new reported cases by day, shows the decrease of COVID-19 cases since the peak in January. There were fears over the spring of a resurgence as cases spiked in April, but the trends are still heading back down.
Hospitalizations are also declining, which has reopened opportunities for elective procedures across the country and helped to restore the flow of patients to home health services.
We reported a 7% decrease in mortalities in May, and June’s trends are even better with a reduction that has now reached 20%.
In last month’s edition of the briefing, we reported that almost the entire state of Michigan was at extremely high risk, but just a month later, even this map looks better. The reduction of risk coincides with the rising number of fully vaccinated people as the vaccination map (in green below) shows. It is worth noting that there are still areas, especially in the west, that remain pockets of high risk.
The nation’s 50 states are not all the same when it comes to success with vaccination due to a variety of factors, not all of which are related to the state’s level of organization or efficiency. Sparsity of population, vaccine availability, and other factors also contribute to varying rates of vaccination. The map below shows vaccination status in terms of the percentage of the adult population of each state.
There are 16 states plus the District of Columbia for which the rate of fully vaccinated people exceeds the national average of 42% – Washington, Oregon, Hawaii, Colorado, New Mexico, Minnesota, Washington DC, Virginia, Maryland, New Jersey, New York, Connecticut, Massachusetts, Vermont, New Hampshire, Rhode Island and Maine. Those are the states at the high end of the spectrum, but at the other end, with less than 34% of the population vaccinated, we find the states of Idaho, Wyoming, Utah, Arkansas, Louisiana, Tennessee, Mississippi, Alabama, and Georgia.
States are also reopening as the map below shows, with only four states – Oregon, New Mexico, Vermont, and Michigan – not fully opened. Of those, Michigan and Vermont are expected to become fully reopened in July.
News
CONNECT Act offers new telehealth options for home-based providers
A new version of the CONNECT (Creating Opportunities Now for Necessary and Effective Care Technologies) Act was introduced by a group of legislators from both houses recently. The bills are S. 1512 and HR. 2903. The National Association for Home Care & Hospice (NAHC) reports that the bills have several elements that will impact home health and hospice providers.
- The legislation, if passed, would allow the Secretary of Health and Human Services (HHS) to waive telehealth requirements related to payment for telehealth services as long as the quality of care is not adversely impacted. These waivers would need to be reassessed at least every three years, but this could be a significant change for home health and hospice providers that are not allowed, currently, to bill for telehealth services because of a statutory limitation in the Social Security Act.
- The legislation would remove geographic requirements related to provision of reimbursable telehealth services.
- Expansion of originating sites to include a patient’s home are included in the bill.
- The bill includes a waiver of telehealth requirements during any public health emergency.
- The bill provides for the use of telehealth services recertification of hospice benefits.
- The bill provides for $3 million in funds for audit, investigation, and oversight activity related to telehealth services.
- The act also mandates that the Secretary of HHS make educational resources available for both beneficiaries and providers.
New campaign aims for 70% vaccinated by July 7
On June 7, the White House announced the Month of Action campaign designed to get at least 70% of all adult Americans vaccinated by July 7. Here are some of the details about the Month of Action campaign and some of the businesses offering incentives and prizes for getting vaccinated.
- KinderCare and Learning Care Group locations will offer free, drop-in appointments for any parent or caregiver who needs childcare to obtain or recover from a vaccination. Bright Horizons and more than 500 YMCAs are also participating. In addition, states are being encouraged to use funding from the American Rescue Plan to provide financial incentives to neighborhood and home-based care providers to join the initiative.
- Selected pharmacies will provide extended hours for vaccination appointments and stay open late every Friday during the month of June to offer vaccination services throughout the night.
- The Vice President will be leading a national tour to highlight the ease of getting vaccinated and to mobilize grassroots outreach and vaccine education efforts.
- There will be a “Mayor’s Challenge” that will be a competition among mayors across the country to see who can grow their vaccination rates the most. So far, more than 50 mayors have indicated that they will participate.
- “Shots at the Shop” will focus on a partnership with the Black Coalition Against COVID, the University of Maryland Center for Health Equity, and Shea Moisture to launch this program to support vaccine education and outreach.
- There will be a College Challenge through which the Administration will provide training, toolkits, and educational materials to assist colleges and universities in their own vaccination campaigns. More than 200 colleges have already signed up for this aspect of the initiative.
- And then there are the business incentives that provide incentives to become vaccinated. For example:
- Anheuser-Busch will give away free beer to adults over the age of 21 on July 4 to celebrate progress against COVID-19.
- CVS has a sweepstakes for vaccinated people to win cruises and tickets to the Superbowl as well as cash prizes.
- DoorDash is giving away $2 million in gift cards to the National Association of Community Health Centers to incentivize vaccinations.
- Major League Baseball teams will be offering on-site vaccinations at games with free tickets to those who get the vaccine.
- Microsoft will give away Xboxes to the Boys & Girls Clubs in areas where COVID-19 rates are high.
- The Kroger Health Community Immunity Giveaway program will give away $1 million to a vaccinated person every week during the month of June, and others will receive free groceries for a year.
- United Airlines’ Your Shot to Fly Sweepstakes for Mileage Plus members will give winners a free year of flights or a roundtrip flight for two in any class of service.
Helping kids to cope with the aftermath of COVID-19
The strangest school year ever has finally ended for most students. While, the pandemic has been hard on every adult I know, it has been far worse for our children in many aspects. As states open up and mask mandates expire, summer activities for kids are returning to a more normal focus. And, nearly everyone is looking forward to next fall when kids will expect to be in school in-person as they normally would. All those things are moving us in the right direction. But a new Wall Street Journal article suggests that remote learning giving way to full in-class instruction in the fall and summer activities like camp and swimming lessons, are resulting in anxiety for some children who have been cooped up the last year and inundated with messages related to the dangers of COVID-19. The article highlights things parents should consider if children are displaying signs of anxiety:
- Deal with evolving changes related to the public health emergency by providing age-appropriate information to the children in your family.
- Acknowledge insecurities by listening and empathizing, remembering that some fears may not be the direct result of COVID-19 and could be related to other causes.
- Make revitalization of social connections a priority this summer and allow kids to renew friendships that may have weakened due to lack of contact during school and other social and extracurricular activities that may have been foregone over the last year.
- Practice now for next fall when school will resume as usual. If a child is transitioning to a new school in a new area or even from grade school to middle school, be even more attentive to this focus in the coming weeks.
- Get kids back to basics – pay attention to sleep routines, nutrition, and outdoor activities.
- Teach positive coping strategies.
- Make sure your own anxieties around getting ‘back to normal’ are also addressed.
The article is worth the read for everyone who is a parent or grandparent.
In-person meetings and conferences are back!
With the introduction of in-person meetings, many event organizers are implementing new ideas to help folks navigate their interactions with others.
Many readers know that in normal times I spend a lot of time on the road speaking at meetings. I love the interaction with people and the fact that I always – every single time I go out to speak – learn new things. Many readers are the same way, and it has been a burden to let go of opportunities for personal interaction. It is with that in mind, that I share a new trend among meeting planners and those just looking to get some folks together for some long overdue personal contact – color coded wristbands that signify how we’re individually and collectively feeling about getting back together again.
A Wall Street Journal article spells it out and I’m thinking of this as a novel – and intriguing – idea. These color-coded wristbands display signs that establish the boundaries for contact. For example, a red wristband could mean no contact and no exceptions, while a cautionary yellow might mean elbow or fist bumps only with green signifying that closer contact such as a handshake or hug might be welcome.
Compliance
Extension of review dates for medical review
In March of 2020 CMS suspended most Medicare fee-for-service audits and then reinstituted them the following August for dates of service prior to March 1, 2020. CMS has now announced that later dates of service can also be the subject of medical review. As a refresher, here are the focus areas:
Home health:
- CGS – edit 5L000, will focus on any home health claim with between two and six visits and a diagnosis of I11.0, Z46.6, J44.1, I10, J44.9, G20, I25.10, N39.0, J18.9 or I87.2.
- NGS – edit 5AAGP will focus on all PDGM claims.
- NGS – edit 5WGMP/5CGMP will focus on final bills for PDGM services on or after January 1, 2020.
- NGS – edit 5WVCP/5CVCP will focus on claims with value code 17 (not assigned by the provider) as an indication of an outlier.
- Palmetto – review for eligibility and medical necessity
Hospice:
- CGS – edit 5M000 will focus on length of stay greater than 730 days.
- CGS – edit 5M0001 will focus on claims with GIP services for seven days or more.
- NGS – edit 5ANKP will focus on hospice length of stay greater than 730 days.
- NGS – edit 5CSLP/5WSLP will focus on claims with GIP services for seven days or more.
- Palmetto – reviews of claims with GIP services for seven or more days
COVID-19 fraud
In late May, a California home health agency and its owner were charged with theft of government property and wire fraud in connection with approximately $230,000 of funding obtained from the Provider Relief Program. The complaint alleges that the funds were misappropriated and that falsified loan documents were submitted to the Economic Injury Disaster Loan Program.
Just about everyone can probably agree that there will be more of these types of actions. My best word to the wise is to be careful with your intent around the use of COVID-19 relief funds, in whatever form they take for your agency, and document thoroughly and carefully.
Clinical
Fully vaccinated people experience milder and shorter illnesses
A new study from the Centers for Disease Control and Prevention (CDC), published June 7, found that mRNA COVID-19 vaccines, such as those offered by Pfizer-BioNTech and Moderna, reduce the risk of infection by 91% when patients are fully vaccinated. The study also showed that, among vaccinated people who got COVID-19 despite being fully vaccinated, the benefits of vaccination included a shorter, milder illness and a reduced chance of spreading the virus to others. The study results were taken from frontline healthcare workers, first responders, and other essential workers.
In the latest analysis, 3,975 participants, starting in December and ending in early April, completed weekly testing for 17 weeks in eight locations across the country. Participants collected their own nasal swabs that were laboratory tested for the virus. If the tests were positive, the specimens were subjected to further testing to determine the amount of detectable virus in the nose and the number of days that participants tested positive. To account for effectiveness, researchers also considered the prevalence of COVID-19 in the geographical areas in which the participants were located.
Vaccinated participants who did get COVID-19 were compared to unvaccinated, participants who got COVID-19. The study found indicate that fully or partially vaccinated participants who developed COVID-19 spent on average six fewer total days sick. They also had about a 60% lower risk of developing symptoms, like fever or chills, compared to those who were unvaccinated.
Administrative
EEOC approval for vaccine requirements and incentives
On May 28, 2021, the Equal Employment Opportunity Commission (EEOC) updated a prior ruling from December 2020 with new guidance that allows employers to establish policies that require employees who enter the workplace to be vaccinated for COVID-19. The overall EEOC guidance makes it clear that such policies must appropriately comply with the reasonable accommodation provisions of the Americans with Disabilities Act (ADA) along with Title VII of the Civil Rights Act.
With this guidance, employers are permitted to offer incentives to employees in return for becoming vaccinated. Vaccination incentives cannot be substantial or coercive in nature and can extend not only to employees but their family members as well. It will be important for employers to understand that vaccination information is considered medical information that must be separately maintained in each employee’s record, for example within a separate manilla envelope within the larger paper record.
It will also be important to understand that reasonable accommodations must be made for employees who remain unvaccinated because of disability as defined by the ADA or a religious belief. The guidance also suggests that, for purposes of the vaccination guidance, reasonable accommodation is considered case specific. In addition to the above, providers should make note of the following:
- Federal EEO rules do not prevent an employer from requiring employees to be vaccinated; however, reasonable accommodation provisions of federal law apply. Reasonable accommodations extend to both physical disabilities and religious beliefs that are sincerely held; however, such accommodations should not impede the ability of the business to operate. Vaccine requirements should not have a disparate impact on any group of employees based on race, color, religion, gender, national origin, or age, and employees cannot be treated differently based on any of these factors.
- Vaccination information is considered confidential medical information under the ADA and this extends both to employees who do – and those who do not – become vaccinated.
- Under the ADA, an employer may require a vaccination for all employees entering the workplace even though some employees may not obtain the vaccine because of a disability, but certain requirements must be met. Those employees with disabilities may need to meet a qualification standard that is applied in like manner to all employees, such as a safety-related standard. If a particular employee cannot meet the standard because of a disability, the employer may not require compliance on the part of the employee unless it can demonstrate that noncompliance would pose a direct threat to the health and safety of the employee or others in the workplace. A direct threat is defined as a “significant risk or substantial harm” that cannot be reduced or removed with reasonable accommodation.
- If an employee seeks an exemption from the vaccination requirement due to pregnancy, the employer must ensure that the employee is not being discriminated against compared to other similarly situated employees. This means that such employees would be entitled to job modifications including telework or changes to schedules and assignments to the extent that such types of job modifications are provided to other employees for other reasons.
- Employers may offer incentives to employees to voluntarily provide documentation of vaccination because such a confirmation is not a disability-related inquiry protected under the ADA with the understanding that such information must be treated confidentially.
- Incentives may be offered by employers as long as they are not so substantial that they would be considered coercive. Employees must not be pressured to disclose protected medical information.
In closing
Summer – my favorite time of the year – is here and things are opening up for many of us. Some of our strides are big and others are small, but they add up to big improvements in the quality of our lives. My best and most fervently held wish is that our gradual return to normalcy is not a fleeting thing and that we are able – with family and friends – to enjoy a spectacular summer. Until next month, keep in mind my usual refrain – be happy and be safe. As always, you are greatly valued and appreciated.