VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been...

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Transcript of VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been...

Page 1: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval
Page 2: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

All conversations and proceedings at any Board of Trustees, committee, or other formal meeting of

VALA or where VALA representatives are participating must abide by the constraints of antitrust laws. There shall be no discussion of

agreements or concerted actions that may restrain competition. Each participant is obligated to speak up for the purpose of preventing any

discussion falling outside the bounds of laws.

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• Please mute your line when not speaking• *6 can unmute telephone lines

• “Raise Your Hand” to be unmuted by host

• Use chat feature to also share questions/comments

• Discussion is being recorded to be shared on VALA’s Health Alert webpage

• Presentation slides will also be shared online with clickable links.

• Statements and information shared are a “work in progress” and may change

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• This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS – Approval # 20210830-1.50-A69429-DL.

• Only those participants pre-registered for the webinar and participating in the live webinar presentation are eligible for CEUs.

• CEUs will be uploaded to NAB for participants that have shared their NAB R number with VALA.

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• VALA Health Alert Webpage• http://www.valainfo.org/healthalert

• Virginia Long-Term Care Task Force Webpage• https://www.vdh.virginia.gov/coronavirus/health-

professionals/virginia-long-term-care-task-force/

• Virginia Department of Social Services• https://www.dss.virginia.gov/facility/alf.cgi

• Centers for Disease Control and Prevention (CDC)• https://www.cdc.gov/coronavirus/2019-

nCoV/index.html

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• Jackson Lewis P.C.• Courtney Malveaux, Attorney at Law

• Argentum• Daniel Samson, Director of Government Relations

• Virginia Department of Social Services• Leigh Burke, Licensing Administrator, Central Regional Office• Kathy Petersen, Licensing Consultant, Division of Licensing

Programs• Leighann Smigielski, Operations Manager, Division of Licensing

Programs• Virginia Department of Health

• Kim Beazley, Deputy Director of the Office of Licensure and Certification

• Christy Gray, Director, Division of Immunization• Virginia Department of Medical Assistance Services

• Bill Lessard, Director, Provider Reimbursement Division

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• Workplace Standards

• VA Department of Labor and Industry’s Workplace Safety Standards

• US Dept. of Labor Paid Leave Exemption – Definition of Health Care Provider

• Testing Updates

• CLIA Requirements

• Testing Types

• Reopening Updates

• Personal Protective Equipment (PPE)

• Reporting of Supplies and Needs

• Supply Availability

• N95 Fit Test Training

• Infection Prevention & Control

• Influenza Vaccine Planning – recommendations & resources

• COVID Vaccine Update

• Funding Opportunities for Assisted Living Communities

• Additional COVID response updates

Page 9: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

• Following slides are duplicates of the slides shared during the August 10, 2020 webinar - only covering highlights and new information today.

• View the Emergency Temporary Standards (ETS) as adoptedby the Safety and Health Codes Board

• View the press release on the ETS with additional information on effective dates

• Outreach, education, and training materials for the ETS can be viewed online

• Report a Positive Coronavirus Case, Workplace Fatality, or Severe Injury

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© 2020 Jackson Lewis P.C.

Virginia Occupational Safety and Health Emergency Temporary Standard for COVID-19

Courtney M. Malveaux

08.20.2020

Jackson Lewis P.C. • Richmond, VA

[email protected] • (804) 212-2862

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• Background on new standard

• Requirements for all employers

• “Medium Hazard” employers

• “High Hazard” and “Very High Hazard” employers

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Background on Emergency Temporary Standard

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• OSHA enforces the federal Occupational Safety and Health Act (the “OSH Act”), 29 USC § 654, which incorporates standards such as

• 29 CFR § 1910 (General Industry Standards)

• 29 CFR § 1926 (Construction Standards)

• OSHA also enforces the General Duty Clause:

“Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”

29 USC § 654(5)(a)(1).

Jackson Lewis P.C. 13

Occupational Safety and Health Administration (OSHA)

OSHA enforces the Occupational Safety and Health Act generally

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• Most private sector employers

• All state and local employers

• Asbestos removal (including federal workplaces)

• Federal military facilities

• Federal enclaves where civil jurisdiction has been ceded to federal government

• Temporary employees working for federal government

• Maritime employment (including shipyards, marine terminals, longshoring)

• USPS contractors

• U.S. Department of Energy sites

• Aircraft cabin crew members

Virginia Occupational Safety and Health (“VOSH”)

VOSH enforces Virginia occupational safety and health law (Title 40.1) for:

OSHA enforces the federal Occupational Safety and Health Act for:

Virginia is a “State Plan” state that governs most of its own workplaces

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• The Virginia Safety and Health Codes Board approves OSHA regulations

• It approved a first-in-the-nation Emergency Standard for COVID-19 on July 15, 2020

• Arose in response to Governor’s Executive Orders

• Effective July 27, 2020

• Six-month duration, with potential permanent standard to follow

• Will “sunset” upon expiration of Governor’s State of Emergency

Jackson Lewis P.C. 15

VOSH Standard for COVID-19

Virginia passed a first-in-nation COVID-19 standard

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Requirements for All Employers under VOSH Jurisdiction

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Jackson Lewis P.C. 17

• Hazard assessment for all job tasks (“Very High,” “High,” “Medium” and “Low”)

• Policies/procedures for employees to report COVID symptoms

• Prohibit known/suspected cases at worksites

• “Flexible” sick leave policies

• System to receive reports of positive tests (within past 14 days) by:

• Employees (including temps and contract employees)

• Subcontractors

• Mandatory handwashing stations and hand sanitizer “where feasible”

• Employers must assess risk levels of employees and suppliers before entry

• Building and facility owners must notify employer tenants of COVID-19 cases

What Is In the Virginia Standard?

General requirements for all employers

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Jackson Lewis P.C. 18

• Employers must notify:

• VA Dept. of Health of COVID-19 positive tests; and

• VA Dept. of Labor and Industry (DOLI) of “hot spots”

• 3 COVID-19 positive tests within a two-week period

• Hazard assessments for all job tasks

• “Good faith” if actual compliance with mandatory/nonmandatory provisions of CDC guidance (if equivalent/greater protection)

• Nondiscrimination for:

• Raising/reporting concerns

• Voluntary PPE use

• Reasonable work refusals

What Is In the Virginia Standard?

General requirements for all employers (cont’d)

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• No required contact within 6’ of known/suspected cases

• Minimal contact with others (e.g., office setting)

• Minimal contact through engineering controls, such as:

• Floor-to-ceiling barriers

• Telecommuting

• Staggered shifts

• Remote delivery

• Mandatory social distancing

• Face coverings

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What Is In the Virginia Standard?

These requirements apply to all “Low Hazard” employers with:

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Requirements for “Medium Hazard” Employers

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• More than minimal contact within 6’ of others

• May include operations/services in:

• Poultry/seafood/meat processing

• Agriculture

• Manual labor

• Commercial transportation

• School campuses

• Daycare/after school care

• Restaurants/bars

• Grocery/convenience stores

• Food banks

• Drug stores/pharmacies

• Manufacturing settings

• Construction (indoor and outdoor)

• Correctional facilities

• Work performed in customer premises (homes or businesses)

• Retail stores

• Call centers

• Package processing settings

• Veterinary settings

• Personal care, personal grooming, salons and spas

• Sports venues

• Homeless shelters

• Fitness, gym and exercise facilities

• Airports

• Train/bus stations

• Healthcare settings that do not involve exposure to known/suspected cases

What is a “Medium Hazard” Employer?

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• When feasible:

• Telework

• Staggered shifts

• Eliminate personal meetings, travel

• Physical barriers

• Implement telework and staggered shifts

• Social distancing

• Deliver services/products remotely or by curbside pickup or delivery

• Reconfigure spaces where employees congregate

• Infectious Disease Preparedness and Response Plan (exception for ten or fewer employees)

• Designated person for implementation

• Employee involvement

• Hazard assessment by job tasks and potential exposure sources

• Employees with other jobs

• Employees’ individual risk factors

• Outbreak contingency plans to cover:

• Absenteeism

• Enhanced workplace control measures

• Cross training/continued operation plans

• Interrupted supply chains/delayed deliveries

Requirements for “Medium Hazard” Employers

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• Prescreening/surveying before each work shift

• Provide face coverings to visitors with suspected cases and employees who can’t social distance

• Infection prevention

• Handwashing

• Cleaning/disinfecting

• Managing/educating visitors

• Identification/isolation of known/suspected cases

• Plan to address subcontractors, temp/contract employee providers, other visitors

• Antiretaliation protections for employees who raise concerns

• Assess, require and communicate PPE use beyond General Industry

Requirements for “Medium Hazard” Employers

Page 24: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

• Written certification to verify workplace hazard assessment that:

• Identifies evaluated workplace

• Certifies evaluation completion with date(s)

• Ensure air handling systems that:

• Are maintained according to manufacturers’ instructions

• Comply with minimum American National Standards Institute (ANSI)/American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standards

• Employee COVID training within 30 days on:

• New VOSH standard

• CDC guidelines (mandatory and nonmandatory)

• Signs/symptoms/methods of transmission

• Risk factors for underlying health conditions

• Asymptomatic/Presymptomatic spread

• Safe and healthy work practices

• PPE

• Antidiscrimination

• Infectious Disease Preparedness and Response Plan

• Retraining

Requirements for “Medium Hazard” Employers

Page 25: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

Requirements for “High Hazard” and “Very High Hazard” Employers

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• Airborne Infection Isolation Rooms for patients

• Autopsy suites for postmortem activities

• CDC Biosafety Level 3 requirements for handling infected specimens

• Limitation of non-employee access

• Signage to report symptoms

• Psychological/behavioral support

• Respiratory protection program

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Requirements for “High Hazard” employers

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Questions?

Courtney M. Malveaux, Esq.804.212-2862

[email protected]

Represents Employers In:

• OSHA Citations

• Regulatory and Employment Matters

• Government Affairs

Regulatory Background:

• Virginia Labor Commissioner

• VA Safety and Health Codes Board

• President, National Association of

Government Labor Officials

Page 28: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

• Definition of Health Care Provider: “For the purposes of Employees who may be exempted from Paid Sick Leave or Expanded Family and Medical Leave by their Employer under the FFCRA, a health care provider is anyone employed at any doctor’s office, hospital, health care center, clinic, post-secondary educational institution offering health care instruction, medical school, local health department or agency, nursing facility, retirement facility, nursing home, home health care provider, any facility that performs laboratory or medical testing, pharmacy, or any similar institution, Employer, or entity. This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions...”https://www.dol.gov/agencies/whd/pandemic/ffcra-questions#56

• Argentum Issue Summary: https://www.valainfo.org//Files/Resources/COVID%20Response/Argentum_COVID19_DOL_Rule_Apr1.pdf

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• April 14, 2020: New York Attorney General sued the Labor Dept. over the agency’s interpretation of ‘health care provider’

• August 3, 2020: New York federal court judge invalidated several key pieces of DOL guidance concerning the Families First Coronavirus Response Act (FFCRA)

This “ruling technically does not apply nationally, and is limited to the Southern District of New York, and perhaps the Second Circuit. Nevertheless, the Court’s opinion is inconsistent with what companies across the country have been doing to comply with the FFCRA since the beginning of April 2020. If the Second Circuit does not stay the Court’s decision pending appeal, then employers who operate in New York as well as other states will have differing obligations depending on where they operate. Employers in other jurisdictions are also urged to exercise caution as they may now be deemed to have notice that the Final Rule is not valid should the decision later be upheld or adopted in other jurisdictions.”

https://www.reedsmith.com/en/perspectives/2020/08/new-york-federal-judge-strikes-down-dol-rules

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Reason for Paid Leave Amount Owed

Subject to a Federal, State, or local quarantine or isolation order related to COVID-19

-OR-Advised by a health care provider to self-quarantine related to COVID-19

-OR-Experiencing COVID-19 symptoms and seeking a medical diagnosis

RATE OF PAY:Paid at either their regular rate or the applicable minimum wage, whichever is higher

MAXIMUM BENEFIT:$511 per day / $5,110 in the aggregate (over a 2-week period)

Caring for an individual subject to a government order or advised by a health care provider to quarantine

-OR-Experiencing any other substantially-similar condition specified by HHS

RATE OF PAY:Paid at 2/3 their regular rate or 2/3 the applicable minimum wage, whichever is higher

MAXIMUM BENEFIT:$200 per day / $2,000 in the aggregate (over a 2-week period)

Caring for a child whose school or place of care is closed (or childcare provider is unavailable) for reasons related to COVID-19

RATE OF PAY:Paid at 2/3 their regular rate or 2/3 the applicable minimum wage, whichever is higher

MAXIMUM BENEFIT:$200 per day / $12,000 in the aggregate (over a 12-week period—two weeks of paid sick leave ($2,000) plus up to 10 weeks of paid expanded family and medical leave ($10,000))

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• Clinical Laboratory Improvement Amendments of 1988 (CLIA): https://www.cdc.gov/clia/index.html

• CDC CLIA Law & Regulations: https://www.cdc.gov/clia/law-

regulations.html

• CMS CLIA Website: https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA/index?redirect=/clia/

• VDH CLIA Website: https://www.vdh.virginia.gov/licensure-and-certification/acute-care-division/clinical-laboratory-improvement-amendments-clia/

Page 32: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

• COVID-19 Testing Types: • Diagnostic Test: PCR-based test, antigen test

• Serology (or antibody) Test

Online Resources about Testing

• VDH COVID-19 Testing:https://www.vdh.virginia.gov/coronavirus/covid-19-testing/

• VDH Testing, Laboratory, and Therapeutics: https://www.vdh.virginia.gov/coronavirus/health-professionals/testing-laboratory-and-therapeutics/

• CDC Guidance on interpreting COVID-19 Test Results: https://www.whitehouse.gov/wp-content/uploads/2020/05/Testing-Guidance.pdf

Page 33: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

VALA COVID-19 DiscussionAssisted Living Updates

August 31, 2020

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ASSISTED LIVING UPDATES

⮚Recently Issued Memos for Assisted Living Facilities

⮚CARES Act Funding for Assisted Living Providers Memo

⮚Personal Protective Equipment Distribution Update

⮚Influenza Vaccinations Memo

⮚Hurricane Season Memo

⮚Point Prevalence Surveys in Assisted Living Facilities

Page 35: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

ASSISTED LIVING UPDATES

⮚Updated Reopening Recommendations for Assisted Living

⮚Document Comparable to Reopening Guidelines for NH

⮚Under Review by VDH

⮚Tips and Best Practices under Development

⮚Mental Health Needs of Residents

⮚Mental Health Needs of Staff

⮚Cognitive Impairment and COVID-19

⮚Return to Work after COVID

⮚Other topics?

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ASSISTED LIVING UPDATES

➢ Reminders – updated policies and procedures

➢ Infection Control

➢ Emergency Preparedness and Response Plan

➢ Reminders – VDH Recommendations

➢ Local Health Department Access

➢All in this together

➢ Accepting Residents upon return of hospitalization

➢Hospitals expressing concern regarding admissions for COVID-19 that for individuals that don’t require hospitalization based on facility refusal to readmit.

Page 37: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

ASSISTED LIVING UPDATES

➢ PPS and Fit Testing

➢ Over 100 facilities opted not to participate in PPS testing

➢ Fit testing

➢ Licensing Offices can loan fit test kits

➢ VHASS

➢ VDSS joining soon

➢ Facilities encouraged to register

➢ https://www.vhha-mci.org/?action=main.welcome&fw1pk=1

Page 38: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

VALA COVID-19 Discussion - Vaccination Update

Christy Gray

Virginia Department of Health

Division of Immunization

August 31, 2020

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❑ Make a Plan - How will your residents and staff get vaccinated?

❑ Influenza vaccine will be vital this year to protect residents and staff but also

reduce transmission within the community for those that cannot be

immunized.

❑ Healthy People 2020 Goal: HCW 90%

❑ #TakeFluOffTheTable

❑ Take the time now to enroll and onboard

with VIIS today!

Influenza Vaccine Planning

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Virginia Immunization Information System (VIIS)

❑ The purpose of VIIS is to create one definitive and accurate

immunization record for all residing in Virginia. This can

increase immunization rates and decrease rates of over-

immunization.

❑ There is no cost associated with maintaining a record in

VIIS or with the use of the registry system. Access to

authorized users, training, and customer support is free.

❑ Data exchange from your office’s EHR to VIIS is possible

and will afford your office most benefits of VIIS without

doing data entry into the EHR and VIIS.

❑ Many offices have successfully integrated VIIS into the

current business flow without disruption. Methods for

integration can be discussed with your VIIS field

consultant.

❑ Find example training video on our website.

❑ Contact [email protected] today!

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COVID-19 Vaccine - Complex Landscape

❑ COVID-19 vaccine is anticipated in 2 phases. The initial phase will have limited

vaccine and provided to identified priority groups.

❑ Vaccine (type, dose, storage and handling, administration, not interchangeable)

❑ Varying efficacy and adverse event profile in different populations

❑ Distribution (central distribution, some direct ship)

❑ Priority groups (HCW, Responders, Essential, High Risk)

❑ Reporting (VIIS and VAMS)

❑ Communication and education especially with those who may distrust public health.

❑ Consider how your LTCF facility and staff will get vaccinated.

❑ Internally by staff or contract vendor

❑ Externally

❑ Healthcare Provider COVID-19 Vaccine Registration coming soon!

❑ Contact [email protected] today!

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• VALA continues to advocate in partnership with other organizations, including Argentum, for additional funding supports for ALFs

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• Virginia Department of Medical Assistance Services (DMAS)• CARES Act Welcome Letter for ALFs

• CARES Act Invoice Workbook with Instructions for ALFs

• DMAS Provider VAMMIS Enrollment Form & Instructions

• Communications Regarding VA Cares Act Funding• Enrollment:

[email protected]

• Invoicing: [email protected]

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Eligible Costs

• Funding can be used for COVID-19 related costs associated with:

• Testing• Employee wages, overtime pay, and bonuses, • Employee benefits, • Contracted services expense,• Employee child care costs, if applicable,• Employee isolation housing, if applicable,• Costs related to screening visitors,• Personal protective equipment and supply costs,• Cleaning and housekeeping supplies, • Telehealth costs, • Resident transfer costs, and• Other COVID-19-related expenditures.

• Payments will be based on demonstrated / invoiced COVID-19 costs only.• Detailed invoicing instructions will be provided in August.

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Payment Amounts

Initial communication from DMAS to providers will provide additional detail on maximum payment formula.

• Nursing Facilities will be eligible for a maximum payment calculated based on the following criteria:

• $27 per resident per day (less $20 Medicaid payment where appropriate)• $80 per resident per day during outbreaks• Additional support for periodic testing• Less payments received from Provider Relief Fund

• Assisted Living Facilities will be eligible for a maximum payment calculated based on the following criteria:

• A facility-based payment of up to $4,000 for each assisted living facility each month (July, August, September, & October)

• An additional daily payment for four months to each assisted living facility based on the number of auxiliary grant (AG) recipients residing in the facility

• This additional payment equivalent to $15.00 per AG resident per day

Page 46: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

Draft Schedule for CARES Act Payments

• July 1, 2020

Eligible costs begin date. Nursing facilities and assisted living facilities should make sure they are documenting their COVID-19 related costs for future invoicing.

• Week of July 27th

DMAS awards administrative support contract. DMAS will contract with an external vendor to support communication with recipients, receipt of invoices, and review and audit of submissions.

• Early August

DMAS or Admin Vendor will send communications to nursing facilities and assisted living outlining the process for submission and necessary documentation, with enrollment, invoice and cost reporting/reconciliation forms.

• Mid-August

Invoices Start Being Accepted / Facilities Enroll for Payment. Facilities can submit invoices and necessary support documentation for costs incurred during July, 2020. Facilities will also have to document funds received from the Provider Relief Fund and DMAS's $20 per diem increase to calculate allowable expenses. Facilities will also have to submit required documentation for enrollment to be paid under this program. Please note, even if a nursing facility is already enrolled as a Medicaid provider, they will have to enroll separately to be paid under this CRF-funded program.

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Draft Schedule Continued

Late August / Early September

DMAS begins making payments. DMAS will process payments on a rolling basis every two weeks following the initial submissions as they are processed by the support vendor.

October 31, 2020

Eligible costs end date. Facilities should submit no costs incurred after October 31 for reimbursement. DMAS and vendor will not accept documentation for costs incurred after this date.

December 1

Final documentation due.

Late December / Early January

DMAS makes final payments.

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• Additional COVID response updates

• Open Discussion/Questions

Page 49: VALA or where VALA representatives are - VALA... · 2020. 8. 31. · •This program has been approved for Continuing Education for 1.50 Participant Hour by NAB/NCERS –Approval

Questions?Comments?

Contact VALA…Judy Hackler

VALA Executive Director(804) 332-2111

www.valainfo.org [email protected]

VALA Health Alert Webpagehttp://www.valainfo.org/healthalert