HHSC Issues Guidance to HCS/TxHmL Providers on Covid-19!!!!

July 27, 2020

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.

https://hhs.texas.gov/about-hhs/communications-events/news/2020/03/hhsc-issues-guidance-hcs-txhml-providers-covid-19

July 28th, 2020      COVID-19 Update For Group Homes- HCS/ICF

The three IDD associations met with HHSC met on 7/28/20 to discuss ongoing COVID-related matters.  A summary of the discussions is presented below.  In reviewing please know that due to time constraints, not all agenda items were able to be discussed.  HHSC will provide the associations with a written update on these items by close of business on July 29, 2020.
 
These are 2 major concerns discussed along with the clarifications about those concerns relayed by HHSC.
1.  Regulatory Staff Entering Group Homes When Screening Requirements are not Met (in particular temperature requirements): Based on provider reports from some regions across the state, the 3 IDD associations requested this item be discussed. In response to these reports, HHSC Regulatory stated that no ICF/IID or HCS surveyor (or other persons) should be admitted into a group home if they do not pass screening requirements, and Regional Program Directors should not intervene (as reported in at least one case) by telling providers they have to let them in.  Before denying admission, however, providers should retake a surveyor’s temperature to rule out any misread of or error in the initial taking of one’s temperature.  Also, surveyors should not be wearing/using the same PPE as they go from home to home. They are required to change PPE prior to each home visit.  Persons experiencing issues with either of these matters are encouraged to contact:
Alyssa Naugle (WS&C) –  Alyssa.Naugle@hhsc.state.tx.us –  or
Renee Blanch-Haley (ICF/IID) –  renee.blanch-haley@hhsc.state.tx.us
2.  In-Home Visits by Guardians:  IDD association representatives discussed issues providers are facing with some guardians (whether ‘professional’ or family member guardians) becoming more insistent about wanting to enter group homes.  It was reported that, in some cases, guardians are just entering the homes or telling direct support staff that they have the  ‘right’ or the ‘authority’ to be in the homes, making it difficult at times for direct support staff to counter.  While all acknowledge the strain current visitor restriction policies place on individuals, guardians and other family members, HHSC encouraged providers and staff to remind guardians and other family members of the current in-home visitation restrictions and the other options available (such as virtual visits, outside visits with appropriate social distancing, etc.) for communicating and visiting with their loved ones.  HHSC added that providers should document these events. 

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.

 

PUBLIC HEALTH EMERGENCY EXTENDED FOR 90 DAYS
The COVID-related public health emergency, which was set to expire July 25, 2020,  has been extended for 90 days (through the end of October 2020).

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 waiversurvey.certification@hhsc.state.tx.us

Though not stated in the message below, in accordance with the April 8, 2020 HHSC COVID-19 HCS/TxHmL webinar, HCS and TxHmL providers are to include the following information when reporting confirmed COVID-19 cases to  waiver, survey and certification: 
~  Provider Name
~  Component Code
~  Contract #
~  Point of Contact Name and Contact Information
~  Individuals:  Name & CARE ID; Number at home; and Number in hospital
~  Number of Staff
 
Report Only Confirmed COVID-19 Cases to HHSC
Providers report only confirmed cases of COVID-19 in staff and individuals receiving services from the provider as a self-reported incident. This is effective immediately. Providers, other than HCS and TxHmL providers, must notify HHSC through TULIP or by calling Complaint and Incident Intake at 800-458-9858. 
HHSC previously required reporting of both presumptive and confirmed cases of COVID-19.
Providers are also required to report communicable diseases to the health authority with jurisdiction over their facility (LOCAL HEALTH DEPT.) This is in accordance with the Communicable Disease and Prevention Act, Texas Health and Safety Code, Chapter 81. It’s also specified in Title 25 of the Texas Administrative Code, Chapter 97.

List of Local Health Authorities for COVID-19 from DSHS

https://www.dshs.texas.gov/regions/Coronavirus-(2019-nCoV)-Local-Health-Entities/

See Link below to handout on the role of the Local Health Authorities 

https://www.dshs.state.tx.us/region1/documents/tmp-LocalHealthAuthority.pdf 

 

Obtaining an HHSC Letter Requesting a Store Waiver for Product

Purchase Limits  

An HCS program provider operating a three or four-person residence may request a letter from HHSC requesting that a store waive product purchase limits for food and personal care items implemented because of the COVID-19 crisis.

Send letter requests to the HCS Policy inbox at HCSPolicy@hhsc.state.tx.us.

Include:

  • HCS program provider name
  • Number of the contract the program provider has with HHSC
  • Address of the three-person or four-person residence
  • Location code of the residence
  • Program provider tax ID.

HHSC will review the CARE and verify the information in the request. Then, HHSC will email a letter to the HCS program provider requesting that a store waive product purchase limits for food and personal care items because of the COVID-19 crisis. Program providers can only use the letter when purchasing such items for a three or four-person residence.

Even though a store is given the letter, it may choose not to waive the purchase limit for the program provider. A program provider can reprint the emailed letter

 

 

 

FAQ’s For Covid-19

04/02/20

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)

https://olympus.soc.texas.gov/files/docs/StarGuides/2020_STAR_SOC_QuickReference_Guide.pdf

  • Public Health Region

https://www.dshs.state.tx.us/regions/default.shtm

  • Local Public Health Organizations

https://www.dshs.state.tx.us/regions/lhds.shtm

  • Texas Division of Emergency Management:

https://tdem.texas.gov/

  • Regional Advisory Councils

https://dshs.texas.gov/emstraumasystems/etrarac.shtm

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:waiversurvey.certification@hhsc.state.tx.us

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ICF COVID-19 Info from HHSC

April 13, 2020

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.

View the COVID-19 Q&A recording here.

TCDD
The Texas Council for Developmental Disabilities (TCDD) is seeking stories about the impact of COVID-19 on persons with disabilities.  The information will be used to inform state agencies, legislators and other state leaders about the needs of the ID/DD population as they make critical decisions regarding policy and funding related to this crisis.
We encourage you to share this information with persons you serve and their families. 
To access details about this TCDD initiative, go to:  https://tcdd.texas.gov/resources/covid-19-information/texas-covid-stories/

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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:

  • 888-963-7111
  • 877-570-9779

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.

  1. 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.
  1. 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
  1. 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.
  1. 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.
  1. 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.