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 Reimbursement, Legal Questions Answered on COVID-19-Related Changes

The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) has issued answers to the frequently asked questions that long term care providers have concerning reimbursement and legal changes resulting from the coronavirus (COVID-19).

Key reimbursement issues include:

Medicare Coverage of Testing: Medicare fee-for-service and Medicare Advantage (MA) plans will cover the cost of COVID-19 diagnostic (polymerise chain reaction or PCR) tests. Tests range in cost from $115 to $500. Medicare Part B will only reimburse approximately $100 for the PCR and $35 for other tests. However, not all labs will bill Medicare directly. AHCA/NCAL strongly recommends that, wherever possible, providers use labs that will bill Medicare, as providers may not be able to bill for these services.

CARES Act Coverage: The CARES Act requires health plans to cover the cost of COVID-19 testing for beneficiaries at no cost to the beneficiary. CMS is requiring MA plans to cover the costs of testing for MA plan beneficiaries. Typically, however, when a test is required by an employer for employment, then the employer is responsible for the cost of the test. If the state is mandating testing, the employer may not be held accountable for the cost of the test, but this has not yet been validated, AHCA/NCAL said. 

CARES Act Grant Funds: The CARES Act Grant Funds can be used to cover costs for resident tests that are not otherwise reimbursable. This does not include testing for residents under a Part A stay where it is included in consolidated billing.

Key legal issues include:

Resident Refusals: Residents who refuse to be tested for COVID-19 cannot be discharged involuntarily, unless the facility is otherwise incapable of caring for residents with a confirmed diagnosis of COVID-19, AHCA/NCAL said.

Employee Refusals: Employers can make COVID-19 testing a condition of employment and terminate or not hire a person who refuses to obtain a COVID-19 test.
AHCA/NCAL said for more information, providers can review the reimbursement and legal section of the association’s 
Preparing for Widespread Testing in LTC Guidance.

In other developments, AHCA/NCAL said the emergence of COVID-19 has compounded the need for nursing centers to have an effective infection prevention and control program. In that vein, the association said it has made available a new and expanded version of its Infection Preventionist Specialized Training, , IPCO Version 2. The online training is recommended for individuals responsible for infection prevention and control in all long term care settings, including assisted living communities. 

IPCO Version 2 is designed to train the Infection Preventionist to run a comprehensive infection prevention and control program. It is also now available for administrators to take to gain a deeper understanding of the infection prevention and control in the overall operation of a nursing facility.

AHCA/NCAL said it recommends that each skilled nursing facility train at least two Infection Preventionists through AHCA/NCAL’s IPCO training program should one Infection Preventionist leave the facility. The training is also highly recommended for assisted living communities because they care for a similar population and can face similar infection risks.

As an added feature to all participants registered for the IPCO Version 2 program, bonus content related to COVID-19 is included. The bonus content includes topics such as: Interim COVID-19 Guidance, courses on personal protective equipment, and N-95 mask use, AHC/NCAL said.

Members will need to login with their AHCA/NCAL usernames and passwords to register for 
IPCO Version 2. For assistance obtaining AHCA/NCAL usernames and passwords, members should e-mail with their name and facility contact information.

In separate news, the Department of Health and Human Services (HHS) has posted a reorganized and updated set of 
Provider Relief Fund FAQs. Structurally, the document now is broken out by Allocation type: Targeted, General, Uninsured, Rural, and Indian Health Services. FAQs of interest to long term care providers that have received grants, specifically skilled nursing facilities, include:

--Additional detail on Attestation—HHS provides information on accepting funds, rejecting funds, as well as how to accept one award but reject another.

--Publication of Payment Data—Through a Centers for Disease Control and Prevention (CDC) data portal, HHS now is displaying award data by provider name and award amount. Tax Identification Numbers (TIN) and provider type are not included in the database available here.

--Tranche 2 General Allocation Formula—HHS shows the formula and discusses why a provider that received a Tranche 1 allocation might not have received a Tranche 2 allocation.

--Payment Portal—HHS offers guidance on how providers without a TIN, such as county-owned providers, may attest and/or apply for funding.  

--Additional Payments—More detail is provided on requesting additional funds in the context of the 2 percent limit.

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