In this Issue
- Please Lend Your Voice to Restore Visitation in Long Term Care Facilities
- New Policy from Department of Public Health Restores Some Visitation Rights in Nursing Homes
- New Guidance from Department of Social Services Restores Some Visitation Rights in Assisted Living Facilities
- Proposed Budget Cuts to Senior Programs Rejected
- Governor Signs Law Extending AB 1629 Reimbursement System for Skilled Nursing Facilities
- Nursing Home and Assisted Living Facilities Are Not Entitled to Residents’ Stimulus Checks
- SB 1207 (Jackson) on Backup Power in Skilled Nursing Facilities Passes Senate by 36-0 Vote, Moves on to the Assembly
- In Memoriam: Donna Myers Ambrogi
Please Lend Your Voice to Restore Visitation in Long Term Care Facilities
New Policy from Department of Public Health Restores Some Visitation Rights in Nursing Homes
On June 26, the California Department of Public Health released a new policy regarding visitation that, for the first time since March, REQUIRES nursing homes to permit visitors for outdoor and indoor visits. Facilities with no current COVID-19 outbreak must permit outdoor visitation. Indoor visits must be permitted if a facility meets six criteria: 1. no current COVID-19 outbreak, 2. a decline in cases in the community, 3. no new COVID-19 cases in the facility for the past 14 days, 4. no staffing shortages and not using a COVID-19 staffing waiver, 5) an adequate testing plan per AFL 20-53, and 6) an approved COVID-19 Mitigation Plan. For indoor visits, only one designated visitor allowed per resident (per visit – more than one visitor may visit, just not at the same time). All visits (indoor or outdoor) must be scheduled in advance with visitors screened for fever or COVID-19 symptoms. All visitors must comply with social distancing (6 feet or more physical distancing), wear facial coverings, and permit staff monitoring to ensure compliance with infection control guidelines.
The new policy may have been partially motivated by CANHR’s ongoing #VisitationSavesLives campaign. Now that residents have some of their rights back, the campaign will advocate for better state enforcement.
New Guidance from Department of Social Services Restores Some Visitation Rights in Assisted Living Facilities
On June 26, the California Department of Social Services released updated guidance regarding visitation in PIN 20-23-ASC that, for the first time since March, REQUIRES assisted living facilities to permit visitors under specified narrow circumstances, and permits indoor and outdoor visitation when certain criteria are met. Providers are required to follow the guidance unless there are contradictory or stricter requirements imposed by the Centers for Disease Control and Prevention (CDC), California Department of Public Health (CDPH), or local health departments.
Facilities MUST allow visitation for “Essential Visitors,” or for “medically necessary visits (e.g. end-of-life) or other urgent health or legal matters that cannot be postponed (e.g. estate planning, advance health care directives, Power of Attorney, transfer of property title).” “Medically necessary” is undefined, but expressly includes end-of-life and likely includes visits to counter extreme depression or physical decline caused by isolation. The guidance also requires that facilities allow visitation on the facility premises where there is 6 feet or more physical distancing, source control and infection control, e.g., drive-by visits or visits through a resident’s window.
Facilities MAY allow additional visits if the following five conditions are met:
- There have been no new transmissions of COVID-19 at the facility for 14 days;
- Facility is not experiencing staff shortages,
- Facility has adequate supplies of PPE and essential cleaning supplies to care for persons in care;
- Facility has adequate access to COVID-19 testing; and
- Facility is requiring visitors to wear face coverings, i.e., facemasks or cloth face coverings.
The guidance also describes various safety protocols/best practices, including: visits taking place outside, to the extent possible; scheduling visits in advance; limiting number of visitors at any one time to avoid having large groups congregate; screening all visitors for symptoms, including temperature screenings; and all parties wearing face coverings and being physically distant during the visit.
Proposed Budget Cuts to Senior Programs Rejected
The California Senate and Assembly soundly rejected the cuts included in Governor Newsom’s May Revise budget proposal, including the cuts to Medi-Cal and home and community-based services such as the MSSP and CBAS programs and the reinstatement of the pre-2017 Medi-Cal Recovery rules. Instead, the Governor and Legislature have agreed to a budget deal that would address the projected $54+ billion deficit by relying on a combination of reserves, borrowing from special funds, temporary furloughs for state workers, limiting corporate tax credits and relying on Congress to pass a relief package for states and local government. Meanwhile, cuts to Medi-Cal and most other social services programs are off the table. However, the Governor could make these cuts effective July 2021 if the state finances do not improve. Unfortunately, the budget did not include extending Medi-Cal coverage to undocumented senior immigrants, but does include intent language to do so should funding become available.
Governor Signs Law Extending AB 1629 Reimbursement System for Skilled Nursing Facilities
On June 29, 2020, Governor Newsom signed into law AB 81, a budget bill that extends the Medi-Cal reimbursement system for freestanding skilled nursing facilities through the end of 2022. Known as “AB 1629” for the 2004 legislation that created it, the failed payment system has been a magnet for unscrupulous operators who have profited at residents’ and Medi-Cal’s expense.
The extension does not contain any of the reforms CANHR recommended, however, it is a somewhat reduced windfall for nursing home chains than they and the Newsom Administration had sought. The amended law provides aggregate rate increases of 3.62 percent through the end of calendar year 2020, 3.5 percent in calendar year 2021 and 2.4 percent in calendar year 2022.
Additionally, skilled nursing facilities will receive increased Medi-Cal payments for any new federal or state mandates plus, under separate authority, a 10 percent rate increase retroactive to March 1, 2020 that will continue until the end of the emergency period.
Collectively, these provisions will increase Medi-Cal payments to skilled nursing facility operators in California by more than $500 million through 2022. These generous increases are on top of multiple multi-billion dollar bailouts the federal government is providing to the nursing home industry.
In addition to increasing payments to nursing home operators, the extension made other changes to the payment system. Some of interest include:
- Beginning in 2021, requiring the Department of Healthcare Services (DHCS) to assess monthly penalties up to $50,000 when SNFs are found to be out of compliance with minimum staffing requirements, minimum wage laws or wage pass-through requirements.
- Increasing penalties, imposed by the Department of Public Health, on facilities for failing to meet the nursing hours or direct care service hours per patient per day statutory requirements.
- Requiring DHCS to audit facility costs and revenues that are associated with the COVID-19 Public Health Emergency to determine whether a facility has adequately used increased Medi-Cal payments associated with the emergency only for allowable costs.
- Requiring a facility that received increased Medi-Cal payments associated with COVID-19 to provide any information requested by DHCS on emergency-related costs and revenues at the time and in the manner specified by DHCS; and requiring DHCS to recoup any amounts of increased Medi-Cal payments that were not used to support the delivery of patient care.
- Requiring DHCS to convene a stakeholder process by September 1, 2021 to develop a successor supplemental payment or similar quality-based payment methodology to replace the existing program, to begin in 2023.
A more complete summary of the changes to the payment system can be found here.
The extension took effect immediately when signed on June 29, 2020.
Nursing Home and Assisted Living Facilities Are Not Entitled to Residents’ Stimulus Checks
The Center for Medicare and Medicaid Services (CMS) released an alert noting that some nursing homes are seizing residents’ economic impact payments (or “Stimulus Checks”) authorized under the CARES Act. This practice is prohibited, and nursing homes that seize these payments from residents could be subject to federal enforcement actions, including potential termination from participation in the Medicare and Medicaid programs. This is also true for those residents of Assisted Living/RCFEs in California, even if they are on the SSI board and care rate. The money belongs to the resident, does not count as income for Medi-Cal purposes, and is exempt as a resource for up to 12 months after receipt. If a facility has taken your stimulus check, contact CANHR or report it to the CA attorney general. See: FTC Consumer Information Notice.
SB 1207 (Jackson) on Backup Power in Skilled Nursing Facilities Passes Senate by 36-0 Vote, Moves on to the Assembly
On June 22, the California Senate unanimously passed Senator Hannah-Beth Jackson’s bill, SB 1207, to help save the lives of California nursing home residents during power outages that may result from public safety power shutoffs (PSPS), emergencies, natural disasters, and other causes.
CANHR and Long Term Care Ombudsman Services of San Luis Obispo County are co-sponsoring SB 1207.
The bill codifies existing federal standards that require skilled nursing facilities to have an alternative source of power to protect resident health and safety and maintain safe temperatures for 96 hours during any type of power outage.
As the COVID-19 pandemic collides with wildfire season, the critical need to keep residents safe in their facilities and out of emergency shelters is greater than ever. Over 2,600 California nursing home residents have died already from the coronavirus. It has never been more apparent that California needs to do a much better job of protecting the lives of nursing home residents.
SB 1207 moves next to the California Assembly, where it will likely be assigned to a policy committee and first be heard sometime during July.
In Memoriam: Donna Myers Ambrogi
With great sadness, CANHR mourns the death of Donna Myers Ambrogi, who died at her home in Pilgrim Place in Claremont, California.
Donna was a close personal friend, a colleague and an inspiration. CANHR (BANHR) was born in the Ambrogi living room in San Francisco in 1983. She was one of the founders and first Board members of BANHR, while also founding and heading up the California Law Center for Long Term Care (CALTC). She was a brilliant, passionate social justice warrior for all of her adult life.
With her husband, Tom Ambrogi, Donna travelled the world working for social justice, including working for the first democratic election in South Africa that elected Nelson Mandela. Among many pieces of legislation spearheaded by Donna, was the first nursing home admission agreement law in California that extended the rights of nursing home residents upon admission.
Upon her “retirement” and move to Pilgrim Place, she was elected to the California Senior Legislature, served on CANHR’s Board of Directors and the Pilgrim Place Board and helped start a regional Medicare HMO – all of which involved improving the lives of others. Donna was a light that never stopped shining, and she leaves a void for those of us who knew her. Thank you, Donna, for sharing your advocacy and life with us.