Governor Northam Announces $246 Million to Support Response to COVID-19 in Long-Term Care Facilities

~ Directs increased public reporting, CARES Act funding for facility testing requirements ~

RICHMOND—Governor Ralph Northam today announced new guidelines and testing requirements for reopening long-term care facilities, and outlined how the Commonwealth will direct $246 million, primarily from federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funding, to support long-term care facilities in their response to COVID-19. In addition, the Governor is directing the Virginia Department of Health (VDH) to make public facility-specific data regarding COVID-19 cases and deaths associated with long-term care facilities.
“The lockdowns of long-term care facilities to protect residents and staff from the spread of COVID-19 have been hard on residents and their families,” said Governor Northam. “These actions will help support long-term care facilities as they ease those restrictions, while keeping their residents safe and ensuring that the public gets accurate information on the spread of this virus in these facilities.”
On May 18, the Centers for Medicare and Medicaid Services (CMS) outlined reopening criteria for nursing facilities. These criteria include a recommendation that all facilities conduct a baseline testing survey, and that facilities with outbreaks test residents and staff weekly. VDH’s state-specific guidelines for nursing home reopening require licensed nursing homes, certified skilled nursing facilities (SNFs), and certified nursing facilities (NFs) to conduct baseline and ongoing testing of all facility staff and residents while those facilities are in the first phase of the reopening process. Testing recommendations for latter phases of the reopening process are under development and will be informed by what is learned in the initial part of reopening. 
Virginia will spend an additional $246 million in new funding to support nursing homes and assisted living facilities in addressing staffing shortages, increasing infection control measures, and purchasing personal protective equipment (PPE), as well as complying with the new testing requirements. The majority of funding will go to nursing facilities, which receive Medicaid payments. More than $56 million is provided for periodic testing of nursing home residents and staff. During the reconvened session in April, Governor Northam and the General Assembly agreed to increase Medicaid reimbursement to nursing homes by $20 per resident per day, to help support facilities.
This additional funding includes $152 million from the Provider Relief Fund that long-term care facilities have received for COVID-related expenses. While assisted living facilities have not benefited from this fund thus far, there is a growing recognition on Capitol Hill that these facilities should receive federal funding to offset their costs. Assisted living facilities will receive $20 million in support, nearly doubling state funding for these facilities, in recognition that these facilities are also experiencing additional costs and have not had the federal support that nursing facilities have received. 
Because a majority of outbreaks in the Commonwealth have occurred in long-term care facilities, VDH, in partnership with the Virginia National Guard, has supported long-term care facilities in conducting “baseline” or point prevalence surveys (testing all residents and staff in the same time period). VDH has a goal to complete these baseline surveys of all Virginia nursing homes by July 15, 2020. 
Governor Northam also announced that, given the changing nature of the pandemic in Virginia, he is directing VDH to release the names of individual long-term care facilities (nursing facilities and assisted living facilities) that have experienced a COVID-19 outbreak.  
VDH has previously released aggregate data about outbreaks in long-term care facilities, given their responsibility to protect patient and facility anonymity under the Code of Virginia. However, due to the widespread nature of this pandemic, it is now unlikely that releasing facility information would compromise anonymity or discourage facilities from participating in a public health investigation. Recently released data from the federal Centers for Medicare and Medicaid Services (CMS) has also been inconsistent, creating public confusion. 
Facility-specific data can be found here.

Health Care Providers Fear Cancellation of Telehealth Coverage After Pandemic Ceases

By Rebecca Elrod
FAIRFAX, Va. --- Meg Fregoso, a nurse practitioner, used to see patients who previously had a lung transplant at Inova Fairfax Hospital. Now she uses telehealth to meet patients. 
Fregoso is one of many health care providers offering more telehealth services due to the COVID-19 pandemic. However, providers are concerned that they will no longer be reimbursed for these services once coronavirus restrictions are lifted. 
The coverage of telehealth for physical therapy services was rare before COVID-19, according to Kara Gainer, director of regulatory affairs at the Alexandria-based American Physical Therapy Association. Now, Medicare and most insurance companies are covering more telehealth services due to the coronavirus, Gainer said. 
Centers for Medicare & Medicaid Services expanded Medicare coverage due to COVID-19, according to the organization’s website. However, the agency will reduce payments, on Jan. 1, 2021, to more than three dozen categories of health care providers, according to APTA.
Challenges still remain for physical therapists as many are uncertain about payment, according to a survey done by the APTA
Gainer works with different groups, such as the American Speech-Language-Hearing Association, to advocate for the continuation of coverage for health care providers. 
“Everyone would be supportive of receiving reimbursement for telehealth services at the same rate as receiving reimbursement for in-person services,” Gainer said.  
Reimbursement is the payment that health insurers send to health care providers for giving a medical service, according to an article by Verywell Health, a website that provides health information.
In the past, Inova considered using telehealth to treat post lung transplant patients, Fregoso said. However since most insurance providers didn’t reimburse this type of service, it wasn’t commonly used. Now, Fregoso and other providers are reimbursed for telehealth visits.
“With everything with COVID, it became kind of critical,” Fregoso said.
Telehealth uses technology like  messages, phone calls and live video conference meetings to provide health care services, according to the American Telemedicine Association.
Jade Bender-Burnett, a physical therapist who serves patients with spinal cord and brain injuries at NeuroPT in Falls Church, used telehealth to serve patients before COVID-19 and has continued to use it. Bender-Burnett spoke about how COVID-19 made telehealth more accessible. 
“One of our biggest barriers to providing virtual treatment sessions has always been reimbursement,” Bender-Burnett said.

Some patients, like Kathy Lindsey, find telehealth appointments more beneficial than visiting the doctor in-person. Lindsey sees an endocrinologist in Fairfax County. She began using telehealth to see her endocrinologist because of COVID-19.

Given the option she would like to continue using telehealth services because it is convenient and efficient, Lindsey said. 

Telehealth’s more prominent role in health care will make private insurance companies and Medicare likely continue to cover these services, according to Gainer. Congress will have to act to ensure continued coverage because the Centers for Medicare & Medicaid Services does not have the authority to make the coverage permanent, Gainer said. 

Legislation has been introduced that would make telehealth coverage permanent for therapy providers, according to Gainer. It is likely the discussion regarding telehealth and introduction of other bills will occur in Congress in the coming months, Gainer said.

“The landscape is forever changed,” Gainer said.

VCU Health CMH Team Member of the Month for May 2020

Photo Caption: (Left to Right) W. Scott Burnette, CEO, VCU Health Community Memorial Hospital presented Dr. Indu Shivaram, the VCU Health CMH STAR Service Team Member of the Month Award for May.  There to congratulate Dr. Shivaram was Dr. Ikenna Ibe, Vice President of Medical Affairs & Chief Medical Officer and Dr. Brenda Palmore, Vice President of Practice Management & Business Development.

Dr. Shivaram has been employed at VCU Health CMH for two years.  As VCU Health CMH's pulmonologist she helps patients with various pulmonary issues and is a vital part of the CMH family of physicians.  The nomination form submitted on her behalf by Mellisa Black, Director of Acute Care Nursing, stated, “Since COVID-19 began, Dr. Shivaram has shown the ICU how much she cares about our team and our patients through her words and actions.  She has consistently provided us with current, evolving information and guidance on caring for our COVID patients.  This has encouraged us to work together as a team to achieve optimal patient outcomes, which is our optimal goal.”

When asked what words of wisdom she would give other employees, Dr. Shivaram stated, “When working as a team, always be there for one another.”  She also said, "I'm proud to provide care to patients here at VCU Health CMH.  We have a small well ran hospital offering some of the best treatment options in a rural setting."  

In addition to the “star” award, Dr. Shivaram received a STAR Service lapel pin, letter of commendation from Administration, a $40 gift certificate, and a parking place of her choice for the month.

Dr. Shivaram currently resides in South Hill, VA.

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