State Requirements and Guidance for Creating Dedicated COVID-19 Long-Term Care Facilities

State Requirements and Guidance for Creating Dedicated COVID-19 Long-Term Care Facilities

On April 8, 2020, the Indiana State Department of Health (ISDH) and Family and Social Services Administration issued guidance for long-term care (LTC) facilities, specifically nursing facilities, to create dedicated COVID-19 buildings. Those interested in transitioning a nursing facility into a dedicated COVID-19 building should email Dr. Daniel Rusyniak (Daniel.Rusyniak@fssa.IN.gov) and Matt Foster (MFoster@isdh.IN.gov) to begin the process.

The proposed benefits to creating dedicated COVID-19 buildings include:

• The conservation of PPE
• The creation of facility expertise
• The provision of facilities/spaces for employees with COVID-19 to continue working
• The ability to transition patients requiring skilled nursing out of hospitals to specific locations when they no longer need acute care

Many of the Waivers issued by CMS and ISDH to date allow for the creation of dedicated COVID-19 areas and buildings, including the Waiver to allow for transfer or discharge as soon as practicable, the Waiver allowing for structural and/or bed changes to be made if certain conditions are met, and various Waivers addressing staffing challenges.

Dedicated COVID-19 buildings will receive a 50% increase to the current average nursing facility rate of

$215.36. Further, all nursing facilities will receive a 4.2% increase in rates independent of whether they are dedicated COVID-19 facilities. These rate increases will be applicable to the duration of the public health emergency and an appropriate, to-be-determined transition period afterward. While IHCA/INCAL continues to advocate for rate increases for all LTC facilities, the guidance only outlines rate increases for nursing facilities at this time.

Dedicated COVID-19 buildings will also have access to testing prior to the movement of residents, even those who are asymptomatic; available training for staff, as needed; and distributions of PPE, as available.

The state guidance provides the following qualifications for a nursing facility to be designated as a dedicated COVID-19 building:

• Develop a mutually agreed upon plan with hospitals for transfer and care of residents at the dedicated COVID-19 facility requiring acute care;
• Be approved by the State as a dedicated COVID-19 facility;
• Have only residents who require nursing home level of care at the facility;
• Identify the building dedicated to the care of COVID-19 patients;
• Be currently open and operational with sufficient beds, equipment, and support (i.e., food, housekeeping, maintenance support) to meet the anticipated number of dedicated beds;
• Be able to staff dedicated facilities or areas;
• Have a written plan of operation addressing defined criteria, and submit the plan for ISDH approval within 30 days of implementation;
• Be State-licensed and CMS-certified;
• Maintain documentation that tracks COVID-19 patients, as well as a detailed understanding of the Minimum Data Sets;
• Update daily COVID-19 available beds and PPE stores in EMResource; and
• Communicate plans with hospitals and ensure all families are notified of the timing and location of resident transfer prior to

ISDH stressed that it expects thorough, transparent communication from dedicated COVID-19 buildings to residents and their families; cooperation between transferring facilities (hospitals and nursing facilities) and receiving facilities to ensure smooth resident transitions; and compliance with the rules governing resident transfers, including delivery of timely notices to residents and the long-term care ombudsman.

IHCA/INCAL issued comments to the ISDH regarding the requirements and guidance for creating dedicated COVID-19 facilities, but many details remain to be determined, including the starting date for enhanced reimbursement, the criteria for the required operations plan, and more. IHCA/INCAL will continue to provide updates as more details are confirmed.

Please contact Zach Cattell (zcattel@ihca.org) if you have questions.