January 10th, 2021
Federal Pharmacy Partnership Program:
Contact Information for COVID-19 Vaccines
Long-term care providers with questions about CVS or Walgreens COVID-19 vaccinations administered through the Federal Pharmacy Partnership program should contact the following:
Email COVID Vaccine Clinics LTCV.
Email Immunize ILTC.
January 7 Texas Medicaid CHIP COVID-19 Information Session.
Future meeting notices and information will continue to be shared on these sites, so please check back regularly.
December 22, 2020
DSHS Issues Guidance About Moderna Vaccination Readiness for Vaccine Administrators
A recording of the DSHS Vaccination Readiness for the Moderna COVID-19 Vaccine webinar held on Dec. 20 and Dec. 21, 2020 is available for vaccinators who could not attend.
Helpful Vaccination Information
Moderna EUA Storage and Handling Instructions (PDF) includes the following:
- Moderna EUA Fact Sheet for Healthcare Providers Administering Vaccine (Vaccination Providers)
- Moderna EUA Fact Sheet for Recipients and Caregivers
CDC’s Moderna Clinical website is live: Moderna COVID-19 Vaccine Information. This website includes the following documents:
- Storage and Handling Summary
- BUD Guidance and Labels
- Storage and Handling Labels
- Vaccine Expiration Date Tracking Tool
- Freezer Storage Loggers (F) and (C)
- Prep and Administration Summary
- Standing Orders Template
December 2, 2020
HHSC Publishes Revised Guidance for Requesting Free COVID-19 Point of Care Antigen Test Kits (PL 20-49)
HHSC has published a revised version of PL 20-49, Process to Request Free COVID-19 Point of Care Antigen Test Kits (PDF), for NF, ALF, ICF/IID, HCS and HCSSA providers. The letter has been revised to update the link for the BinaxNOW training for staff who will be administering COVID-19 tests using the BinaxNOW Ag card.
Survey – DSHS Bamlanivimab Allocations in Texas Long-term Care Facilities
The Texas Department of State Health Services wants to ensure that all nursing facilities and other long-term care facilities have the chance to be included in future allocations of the novel monoclonal antibody bamlanivimab and possibly other novel therapeutics.
This month, the U.S. Health and Human Services announced its plan to ship bamlanivimab — the Eli Lilly monoclonal antibody treatment issued emergency use authorization by the FDA Monday, November 9 — to states as provided by the federal government. The federal government initially directed that the product be distributed only to hospitals or hospital-affiliated facilities; however, U.S. HHS is planning to change their initial policy and allow product to be distributed to other types of facilities as early as this week. These facilities may include nursing facilities and infusion centers, among others.
Because bamlanivimab is authorized for use in outpatients, DSHS would like to have a better understanding of outpatient settings that would be willing to act as a provider of this novel therapeutic. A survey of healthcare facilities is provided at the end of this alert that will allow facilities to report their interest in becoming a provider of this scarce resource.
Bamlanivimab is still a scarce resource with an extremely limited supply coming to Texas, and those supplies are being directed to regions with the greatest burden of COVID-19. Because of this, many healthcare facilities will not receive an allocation of bamlanivimab. However, nursing facilities and other long-term care facilities could be important partners in maximizing the potential of this therapeutic and DSHS would like to know which facilities would be willing to provide it to their residents.
DSHS would like to ensure that there are providers across the state that are able to provide this therapeutic to higher risk individuals.
Some of the information for which you will be asked in the survey includes your facility’s point of contact, address, phone number, email address, and pharmacy license number. Please read the bamlanivimab EUA and healthcare provider fact sheet prior to completing the survey to ensure that your facility and patient population will meet product use requirements.
If your facility has interest in becoming a provider of bamlanivimab, please respond to this survey.
DSHS and HHSC Long-term Care Regulation appreciate everything that you and your facility is doing to keep Texans healthy and safe. Thank you for your consideration of becoming a provider of this novel therapeutic.
December 2, 2020
Reminder: Requirements and Protocol for COVID-19 Emergency Staffing Requests
HHSC LTCR offers emergency staff for facilities facing severe critical shortages. Emergency staffing is only approved for facilities that can’t provide necessary care to residents due to staffing shortages. Emergency staffing is temporary while facilities get alternative staffing resources.
Facilities must have staffing contingency plans in place to address potential staffing shortages due to COVID-19. (42 CFR §483.73(b)(6)).
Facilities are required to have separate staff assigned to each COVID-19 cohort and not share staff between cohorts unless necessary to maintain adequate staffing (40 TAC §19.2802(i)).
Facilities may only request emergency staffing from HHSC if all the following contingency strategies have been exhausted.
- Share staff between unknown COVID-19 status and positive COVID-19 cohorts (see CDC guidance).
- Contact staffing agencies, nearby health care facilities, partners, or local colleges or health care centers to identify supplemental staff. (40 TAC §19.2802(j))
- Identify alternate facilities with adequate staffing to care for residents with COVID-19.
- Note: Nursing facilities must contact their LTCR Regional Director and local health department before using staff who are asymptomatic and have, or may have, COVID-19. This is generally only allowed in emergencies. Implement or attempt all other staffing contingency strategies listed above before this step.
If a facility has implemented or attempted each item listed above and still does not have adequate staff to meet critical staffing levels, the facility must contact the Regional Director for their LTCR Region to request emergency staffing.
If approved for emergency staffing, facilities must submit a transition plan for addressing shortages that includes the following.
- Forecasted timeline for when COVID-19 positive staff will return to work, using the CDC’s Return to Work criteria, and when emergency staff can be released.
- Acquiring temporary staff or recruiting new hires.
- All other strategies for ensuring critical staffing shortages are fulfilled as soon as possible.
December 2, 2020
Risk/Benefit Return to Activity Form (Free from our friends at HRS)
This could be very helpful for considerations for returning to work, Day Hab, Volunteer Jobs, etc…
November 22, 2020
COVID-19 Guidance for Activities, Dining, and Volunteers for the Holidays (PL 20-53)
HHSC publishes Provider Letter 20-53 Guidance for Activities, Dining, and Volunteers (PDF). The letter outlines provider responsibilities for resident activities, including communal dining and holiday-related activities.
The letter also gives specific stipulations on the use of volunteers and guidance on the protocol for residents who leave a facility.
This guidance can be used as a general reference through the duration of the COVID-19 pandemic.
HHSC Issues Guidance to HCS/TxHmL Providers on Covid-19!!!!
HHSC Long-term Care Regulation has updated the COVID-19 Response Plan for HCS residential providers (PDF). The document provides guidance on response actions in the event of a COVID-19 exposure.
Provider Letter 20-12, HHSC Guidance to HCBS and TxHmL Program Providers on Covid-19, is now available. HHSC encourages program providers to review this guidance. Remember, no non-essential visitors, see definition in the letter and providers must refrain from sending individuals to Day Habilitation and Community Events! See link below.
July 28th, 2020 COVID-19 Update For Group Homes- HCS/ICF
Reminder to LTC Facilities about Death Reporting Requirements
July 22, 2020
The following are HHSC’s requirements for care facilities to report resident/individuals’deaths to HHSC, including deaths from COVID-19.
- Intermediate care facilities must report all deaths to Complaint and Incident Intake within one hour. See:
- Home and Community-based Services and Texas Home Living Program Providers must report all deaths of people receiving HCS or TxHmL services to HHSC by the end of the next business day following the death or the program provider’s learning of the death. See IL 12-28.
***Note: If the death may have been from abuse, neglect or exploitation, more reporting requirements may exist.
COVID-19 HCS Interest List Reduction and Promoting Independence Slot Releases
Information letter (IL) 2020-27 was released to provide updated information on Home and Community-based Services and Local Intellectual and Developmental Disability Authorities. It replaces IL 20-15, COVID-19 HCS Interest List Reduction Slots, previously issued on April 9 and revised on April 23, 2020.
HHSC is resuming the release of HCS Interest List Reduction Slots starting June 1, 2020. HHSC is continuing releases of HCS Promoting Independence Slots. LIDDAs will request the following HCS Promoting Independence Slots:
- Crisis diversion
- Nursing facility diversion
- Young adults aging out of foster care
- Nursing facility transition
- Nursing facility transition for children
- SSLC transition
The weekly webinars for Medicaid CHIP COVID-19 Information have been canceled and instead, HHSC will be providing a post to a pre-recorded session online for viewing at your convenience to reduce the potential for technical difficulties. These information sessions will continue to share information about the actions taken to implement various Medicaid/CHIP flexibilities in response to the COVID-19 pandemic. HHSC will continue to work on additional flexibilities across the programs and will update stakeholders each week on new implementations and issued guidance. Links to each week’s information session will be posted on the HHS COVID-19 Medicaid & CHIP webpage (https://hhs.texas.gov/services/health/coronavirus-covid-19/medicaid-chip-services-information-providers) by 1:00 p.m. CT on April 16, and each Thursday going forward.
LTC Providers Required to Report COVID-19 to HHSC
Effective immediately, a provider must report every confirmed case (only confirmed cases) of COVID-19 in staff and individuals receiving services from the provider as a self-reported incident. A presumptive or confirmed case is considered a critical incident.
Providers (other than HCS and TxHmL providers) must notify HHSC through TULIP or by calling Complaint and Incident Intake (CII) at 1-800-458-9858.
HCS and TxHmL providers must notify HHSC at firstname.lastname@example.org
List of Local Health Authorities for COVID-19 from DSHS
See Link below to handout on the role of the Local Health Authorities
FAQ’s For Covid-19
From Stakeholder’s Meetings March 16th-31st (Draft)
Contact Information For Other Questions:
Can individuals eat meals together?
Answer: As stated in PL 20-22, HHSC recommends canceling communal dining, however, HHSC is not prohibiting individuals in a three-person, four-person, or host home/companion care residence from dining together. HHSC recommends that if individuals dine together, staff members help ensure that the individuals practice social distancing at the dining table. HHSC also recommends that staff members plate the individuals’ food and help ensure they do not share serving spoons, utensils, plates, cups, or other related items.
Do local shelter-in-place orders prohibit an individual from leaving and returning to the home?
Answer: Shelter-in-place orders issued by local governments may vary, but in many instances require individuals to stay home unless they need to take care of a medical-related issue, go to the grocery store, or exercise outdoors while practicing social distancing. Many also require non-essential businesses to close. They do not prevent persons from returning to their residence. Program providers will need to comply with the restrictions and orders issued by their local government. Departures that are not health-related are strongly discouraged, and HHSC recommends that if an individual chooses to temporarily leave a three-person, four-person, or host home/companion care residence, the individual be allowed to return to the residence. If an individual leaves a residence temporarily for any reason, the individual must be screened upon return. If the individual meets any of the screening criteria described on page 2 of PL 20-22, HHSC recommends that the program provider isolate that individual in one area of the residence to protect other individuals in the residence.
Can providers tell people not to return for a period of time after vacation, home visit, etc.?
Answer: HHSC recommends that a program provider advise an individual of any local social distancing requirements, public gathering restrictions, or shelter-in-place orders. Departures that are not health related are strongly discouraged, and HHSC also recommends that if an individual chooses to temporarily leave a three-person or four-person residence or residence in which host home/companion care is provided, the individual be allowed to return to the residence. If an individual leaves a residence temporarily for any reason, the individual must be screened upon return. If the individual meets any of the screening criteria listed on page 2 of PL 20-22, HHSC recommends that the program provider isolate that individual in one area of the residence to protect other individuals in the residence.
What signage should be posted at the entrance of a home?
Answer: HHSC’s recommendations about signage at a three-person or four-person residence or a residence in which host home/companion care is provided are addressed on page 3 of PL 20-22.
If there is a fire or an emergency medical situation, do emergency responders need to be screened before entering a home?
Answer: Three-person, four-person or host home/companion care homes should not require screening of emergency services personnel in the event of an emergency.
Who is expected to screen PAS/HAB staff at an own home or family home?
Answer: HHSC does not have requirements governing the screening of these staff before they enter an individual’s own home or family home. HHSC recommends that the program provider assist the individual or the individual’s family members in monitoring the health of CFC PAS/HAB service providers as much as possible.
Are individuals required to continue receiving all services, or will there be exceptions for non-essential services?
Answer: As stated in PL-20-22, program providers are required to ensure that an individual’s critical needs are met. HHSC is not prohibiting the provision of non-critical services to individuals; however, providers must comply with any social distancing requirements, public gathering restrictions, or shelter-in-place orders issued by local governments. Providers can arrange for non-critical services to be delivered to an individual through a method other than an in-person visit to a health care professional, such as by telephone, Skype etc.
Can providers suspend routine doctor visits/therapy visits and/or use electronic visits instead?
Answer: Program providers can reschedule appointments for non-critical services, including routine doctor and therapy visits, or arrange for those services to be delivered through a method other than an in-person visit, such as by telephone, Skype etc.
Are individuals allowed to attend day hab if they want to attend?
Answer: HHSC has issued IL 20-09, which explains changes to allow day habilitation to be provided in the home. HHSC recommends program providers protect individuals by refraining from attending day habilitation, and events in public where more than 10 people are gathered. HHSC is not prohibiting the provision of non-critical services to individuals, which might include day habilitation. However, program providers must comply with any social distancing requirements, public gathering restrictions, or shelter-in-place orders issued by local governments.
Can providers bill for in-home day habilitation for host home companion care? If so, when?
Answer: HHSC has issued IL 20-09, which explains changes to billing requirements for the provision of day habilitation in an individual’s residence.
I have staff who have called in sick and simply can no longer work due to child care issues. What do I do when there are not enough staff for coverage?
Answer: As stated in PL-20-22, program providers are required to staff homes and ensure that an individual’s critical needs are met.
We have quite a few service recipients working. The guidance calls for limiting visitors but does not speak to whether providers should try to keep people home from work. What do we do?
Answer: HHSC recommends that a program provider advise an individual of any local social distancing requirements, public gathering restrictions, or shelter-in-place orders. Further, if an individual chooses to leave a three-person, four-person, or host home/companion care residence to work, HHSC recommends the individual be allowed to return to the residence but be screened upon the return. If the individual meets any of the screening criteria described on page 2 of PL 20-22, HHSC recommends that the provider isolate the individual in one area of the residence to protect other individuals in the residence.
How do HCS and TxHmL program providers get personal protective equipment (PPE)?
Answer: Program providers can contact the following organizations to ask about obtaining PPE:
- State of Texas Assistance Request (STAR)
- Public Health Region
- Local Public Health Organizations
- Texas Division of Emergency Management:
- Regional Advisory Councils
Where do HCS and TxHmL program providers go for COVID-19 information?
Answer: Reliable sources of information include:
- The Centers for Disease Control and Prevention
- The Texas Department of State Health Services
- The Health and Human Services Commission
Who do I call if staff or individual tests positive for COVID-19?
Answer: Contact the local health department, or the Department of State Health Services (DSHS) if there is no local health department. Additionally, program providers must also report this information to HHSC at:email@example.com
ICF COVID-19 Info from HHSC
A recording of the April 9, 2020, ICF/IID COVID-19 Q&A with HHSC LTC Regulatory and DSHS is now available. It’s for those who could not attend the webinar.
New Guidance for LTCR Providers on Coronavirus
LTCR urges all providers to review the Centers for Disease Control’s new guidance on strategies to prevent the spread of COVID-19 in long-term care facilities. To ensure you have the most current information on COVID-19, visit the CDC and DSHS websites. For questions or guidance, call one of the DSHS hotlines:
All providers must continue to follow all laws, regulations, guidance and their own internal policies and procedures related to infection control.
From The CDC website:
Key Strategies to Prepare for COVID-19 in Long-term Care Facilities (LTCFs)
COVID-19 cases have been reported in all 50 states, the District of Columbia, and multiple U.S. territories; many having wide-spread community transmission. Given the high risk of spread once COVID-19 enters a LTCF, facilities must act immediately to protect residents, families, and staff from serious illness, complications, and death.
- Keep COVID-19 from entering your facility:
- Restrict all visitors except for compassionate care situations (e.g., end-of- life).
- Restrict all volunteers and non-essential healthcare personnel (HCP), including consultant services (e.g., barber, hairdresser).
- Implement universal use of source control for everyone in the facility.
- Actively screen anyone entering the building (HCP, ancillary staff, vendors, consultants) for fever and symptoms of COVID-19 before starting each shift; send ill personnel home. Sick leave policies should be flexible and non-punitive.
- Cancel all field trips outside of the facility.
- Identify infections early:
- Actively screen all residents daily for fever and symptoms of COVID-19; if symptomatic, immediately isolate and implement appropriate Transmission-Based Precautions.
- Older adults with COVID-19 may not show typical symptoms such as fever or respiratory symptoms. Atypical symptoms may include new or worsening malaise, new dizziness, or diarrhea. Identification of these symptoms should prompt isolation and further evaluation for COVID-19.
- Notify your state or local health department immediately (<24 hours) if these occur:
- Severe respiratory infection causing hospitalization or sudden death
- Clusters (≥3 residents and/or HCP) of respiratory infection
- Individuals with suspected or confirmed COVID-19
- Actively screen all residents daily for fever and symptoms of COVID-19; if symptomatic, immediately isolate and implement appropriate Transmission-Based Precautions.
- Prevent spread of COVID-19:
- Actions to take now:
- Cancel all group activities and communal dining.
- Enforce social distancing among residents.
- Ensure all residents wear a cloth face covering for source control whenever they leave their room or are around others, including whenever they leave the facility for essential medical appointments.
- Ensure all HCP wear a facemask or cloth face covering for source control while in the facility. Cloth face coverings are not considered personal protective equipment (PPE) because their capability to protect healthcare personnel (HCP) is unknown. Cloth face coverings should NOT be worn instead of a respirator or facemask if more than source control is required.
- If COVID-19 is identified in the facility, restrict all residents to their rooms and have HCP wear all recommended PPE for care of all residents (regardless of symptoms) on the affected unit (or facility-wide depending on the situation). This includes: an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and gown. HCP should be trained on PPE use including putting it on and taking it off.
- This approach is recommended because of the high risk of unrecognized infection among residents. Recent experience suggests that a substantial proportion of residents could have COVID-19 without reporting symptoms or before symptoms develop.
- When a case is identified, public health can help inform decisions about testing asymptomatic residents on the unit or in the facility.
- Actions to take now:
- Assess supply of personal protective equipment (PPE) and initiate measures to optimize current supply:
- If you anticipate or are experiencing PPE shortages, reach out to your state/local health department who can engage your local healthcare coalition.
- Consider extended use of respirators, facemasks, and eye protection or prioritization of gowns for certain resident care activities.
- Identify and manage severe illness:
- Designate a location to care for residents with suspected or confirmed COVID-19, separate from other residents.
- Monitor ill residents (including documentation of temperature and oxygen saturation) at least 3 times daily to quickly identify residents who require transfer to a higher level of care.