Welcome To The ALF Provider COVID-19 Webinar With LTCR .

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Welcome to theALF ProviderCOVID-19 Webinarwith LTCRApril 28, 2021

HandoutA pdf version ofthis presentation isavailable in theHandout sectionof your controlpanel. Save the fileto your computerto view or printlater.2

COVID-19 ResourcesAvailable resources and tools for ALFs: COVID-19 Response Plan COVID-19 Emergency Rules §553.2001 §553.2003 Rev 4/23 §553.2004 Frequently Asked Questions ALF FAQ Provider Letters Texas Division of EmergencyManagement - interactive map forfinding testing resources3

Webinar FrequencyALF Provider COVID-19 webinarfrequency is changing from weekly toevery other week starting in May.Upcoming webinar schedule: May 5, 2021 May 19, 2021 June 2, 2021 June 16, 2021 June 30, 20214

Revised §553.2003HHSC Long-term Care Regulation haspublished revised COVID-19 ResponseExpansion of Reopening VisitationEmergency Rules (PDF), for assistedliving facilities.The rules were updated to specify thatvisitors under the age of 2 are exemptfrom all requirements related towearing masks.5

Update on Johnson &Johnson VaccineDSHS is recommending that vaccineproviders in Texas resumeadministering the Johnson &Johnson/Janssen COVID-19 vaccinefollowing the recommendation from theCDC and FDA.More info: DSHS News Release Frequently Asked Questions Johnson &Johnson Safety Information Updated Johnson & Johnson EUA Fact Sheetfor Recipients and Caregivers6

Six Foot Social Distance atRound Table7

CDC Guidance for FullyVaccinated PeopleCDC updated guidance: Non-healthcare settings - InterimPublic Health Recommendations forFully Vaccinated People Healthcare settings - UpdatedHealthcare Infection Prevention andControl Recommendations inResponse to COVID-19 Vaccination8

Vaccination ReportingProviders must report COVID-19vaccination data for residents and staffto HHSC within 24 hours of thevaccinations.HHSC expects providers to report allknown data, no matter where thevaccine was administered or whoadministered it.9

Vaccination Reporting Continued A facility that is aware of unreportedresident or staff vaccinations mustenter those into the survey by April 20,2021.Failure to report known vaccinationsmay result in a citation from HHSC.This supersedes previous guidance.10

Vaccination Reporting Continued For example, the facility must report if: The facility hosted a vaccine clinic onsite for residents or staff. The facility transported residents orstaff to an offsite location such as apharmacy, doctor’s office, or vaccinehub for vaccination. Individual residents or staff weretransported, by family or privatetransportation, to an offsite locationfor vaccination.11

Vaccination Reporting Continued Report vaccination data via SurveyMonkey tool: https://www.surveymonkey.com/r/SRDM2GY Report vaccination data for residentsand staff, not essential caregivers12

Enroll in NHSNCOVID-19 ModuleHHSC has published the NationalHealthcare Safety Network Long TermCare Facility COVID-19 ModuleEnrollment (PDF). The letter explainswho can report into the NHSN COVID19 module including ALFs.Enrolling in the NHSN COVID-19module provides LTC facilities with asecure reporting platform.The NHSN reporting system has fewersystem requirements than the DSHSsystem. Some providers may prefer itsuser interface.13

When to QuarantineResidents and StaffQuarantine decision trees for ALFresidents and staff available fordownload in Handout section.Help you determine when to quarantineresidents and staff based on: Previous recovery from COVID-19within the last 90 days Vaccination status Symptomatic/asymptomatic status14

Vaccinated StaffFully vaccinated staff with higher-riskexposure* do not have to be restrictedfrom work for 14 days followingexposure if they are asymptomatic.*Higher-risk exposure means prolongedexposure (a cumulative 15 or more minutesduring a 24-hour period) to residents withCOVID-19 infection when the staff member’seyes, nose, or mouth are not covered.CDC Guidance updated March 10.15

Staffing Shortage due toCOVID-19CDC guidance allows asymptomatic,fully vaccinated staff who are notknown to be infected to continueworking provided: Staff should report temperature andabsence of symptoms each day beforestarting work (i.e., staff screening). Staff should be tested and, if found tobe infected with COVID-19, should beexcluded from work until they meet allReturn to Work Criteria.16

When to QuarantineResidentsFor asymptomatic residents,quarantine is no longer recommendedfor residents who are being admitted toan ALF if they are: fully vaccinated and have NOT had prolonged closecontact with someone with COVID-19in the prior 14 days.17

When to QuarantineResidents Continued This updated quarantine guidanceapplies to: new admissions, readmissions, and residents who have gone overnightas long as the resident DID NOThave prolonged close contact withsomeone with a COVID-19 infection.18

Revised ALF VisitationGuidance (PL 2021-12)HHSC LTCR published Provider Letter2021-12 (replaces PL 20- 42 and PL20-23) COVID-19 Response –Expansion of Reopening Visitation(PDF).The letter clarifies COVID-19 visitationflexibilities permitted by newly revisedALF Expansion of Reopening VisitationEmergency Rules (PDF).19

Visitation RulesThe rules: allow for less restrictive visitationonce a facility has offered* acomplete series of COVID vaccines toresidents and staff and documentedeach resident’s choice to vaccinate ornot. See §553.2003(g).*Note – offer in this context means toadminister, arrange/assist, OReducate/give information about theCOVID-19 vaccine AND documentedthe resident’s choice.20

Visitation Rules Continued The rules: allow for more restrictivevisitation if a facility has NOT madethis offer* to residents and staff. See§553.2003(h).*Note – offer in this context means toadminister, arrange/assist, OReducate/give information about theCOVID-19 vaccine AND documentedthe resident’s choice.21

VisitationHas the facility administered,arranged, or given information aboutthe COVID-19 vaccine anddocumented resident’s choice?Yes – lessrestrictive visitationrulesNo – Morerestrictive visitationrules§553.2003(g)§553.2003(h)22

Less Restrictive Visitation No attestation form for visitation isrequired. A resident may choose to have closeor personal contact with their visitorduring the visit. There may be up to two permanentlydesignated essential caregivers perresident and up to two designatedessential caregivers may visit theresident at the same time.§553.2003(g)23

More Restrictive Visitation There may be up to two permanentlydesignated essential caregivers per residentand one designated EC may visit at a time. Submit LTCR Form 2196 to the RegionalDirector. If approved, the facility must allowfor outdoor visits, open window visits,vehicle parades and indoor plexiglass visitsinvolving residents and personal visitors. Ifpreviously submitted and no changes, donot resubmit. A facility must receive an approved visitationdesignation before it can begin permittingoutdoor visits, indoor plexiglass visits, openwindow visits and vehicle parades.§553.2003(h)24

Applicable to AllVisitation A facility must not require a visitorto provide documentation of COVID19 negative test or COVID-19vaccination status as a condition ofvisitation or to enter a facility.25

Applicable to AllVisitation Continued Masks: Visitors and essential caregiversmust wear masks at all times. PerCDC, children 2 years of age oryounger do not have to wear a mask. Residents must wear masks at alltimes (if tolerated). If the residentdoes not tolerate wearing a mask,the facility documents in the residentrecord.26

Applicable to AllVisitation Continued Scheduling: Schedule visitationappointments to allow time forcleaning and sanitization of thevisitation area between visits. Screening: Screen all visitorsaccording to requirements.27

All ALF EC Visits EC visits allowed for all residentswith any COVID-19 status. Resident must wear facemask, iftolerated. Resident may removemask to eat or drink during visit . EC must wear mask throughout thevisit. EC may not eat or drink duringvisit. No EC testing or testing strategyrequired. No staff escorting to/from EC visits.28

ALF Visitation ComparisonHHSC LTCR published VisitationComparison Table (PDF) for ALFs.The table can be used as a tool to helpproviders determine the visitationrequirements for those providers whohave offered the COVID-19 vaccine andthose who have not.The next slides review the visitationcomparison table.29

Visitation ComparisonOffered vaccine anddocumentedresident’s choiceEssential Caregiver(EC) VisitsNumber of EC VisitorsAllowed for all residents with any COVID status.Up to 2 EC can visit aresident at the sametime.End-of-Life (EOL)VisitsScreeningFacemaskHas not offeredvaccine anddocumented choiceOnly 1 EC can visit aresident at a time.Allowed for all residents with any COVID status.Screen all visitors except emergency personnel. All visitors must wear facemask at all timeswhile in the facility. Per CDC, children 2 years oryounger do not need to wear a mask.Residents must wear facemasks, if tolerated.Document if not tolerated.30

Visitation ComparisonOffered vaccine anddocumentedresident’s choiceIndoor and OutdoorVisitsAllowed for residentswith COVID-negativestatus.Has not offeredvaccine anddocumented choiceWith HHSC approval(Attestation Form 2196),the following are allowedfor COVID-negativeresidents: Physical Contactbetween residentsand visitorsSalon ServicesAllowed for EC, EOL, andvisits with COVIDnegative residents.open window visits,vehicle parades,outdoor visits, andplexiglass indoorvisitsAllowed only for EC andEOL visits.Only for residents with COVID-negative status.31

Vaccine RefusalIf the COVID vaccines were“offered” but not accepted byresidents, does our facility meetthe criteria of having “offered” thevaccine?Yes, as long as the facility hasdocumented each resident’s choice tovaccinate or not to vaccinate.32

Difference Between EssentialCaregiver and VisitorWhat is the major differencebetween an Essential Caregiverand a visitor? EC resident can be COVIDpositive, COVID-negative, COVIDunknown Visitor resident must be COVIDnegative33

Number of VisitorsThe number of visitors that can visit aresident at a time is not defined in rule. Limited by scheduling and size ofvisitation area No physical distancing necessaryamong visitors in the same group ECs can visit with another group ofpersonal visitors (for COVID-negativeresidents)34

EntertainersEntertainers may come to the facility providedthey: Pass screening prior to entry. Wear a facemask at all times in the facility. Maintain physical distance of 6-10 ft fromaudience.Remember: COVID cohorts cannot mingle together. Performance area must be sanitized afteruse and if used for different cohorts,sanitize between each performance.35

Transportation toOutingsFacility sponsored outings are allowed,but residents must maintain physicaldistancing, which may limit how manyare in the vehicle at one time.Residents and staff must wear masks.Hand hygiene must take place as well.36

Dining and ActivitiesDining and activities are acceptablewithin resident cohorts, but theresidents must maintain physicaldistancing, regardless of vaccinationstatus.37

Facility ToursAn ALF may allow in-person tours for apotential resident. The following wouldapply to in-person tours: limit in-person tours to COVIDnegative areas of the building ensure all tour visitors wear masks ensure all tour visitors maintainphysical distancing betweenthemselves and all staff, residents,and other visitors38

Facility Tours Continued An ALF may allow in-person tours for apotential resident. The following wouldapply to in-person tours: limit in-person tour groups to notmore than three persons schedule all in-person tours inadvance39

Salon ServicesSalon service visits are permitted forresidents with COVID-negative status: Visit may occur outdoors, inresident’s bedroom, or another areathat limits visitor movement Salon service visitor must wearfacemask. Resident must wear facemask, iftolerated. Testing strategy for salon servicesvisitors.40

Revised PL 2020-49HHSC revises guidance allowing LTCproviders to use free COVID-19 POCantigen tests on anyone.Provider Letter 2020-49 (Revised)Process to Request Free COVID-19Point of Care Antigen Test KitsThe revised letter expands the ability ofLTC providers to use the requested freeBinaxNOW COVID-19 point of careantigen test kits on anyone.41

Free BinaxNOW COVID-19 POCTests Available for LTC ProvidersProviders must attest to adhere to certaintraining and reporting requirements andhave one of the following. Current Clinical Laboratory ImprovementAmendment Certificate of Waiver Current CLIA laboratory certificateComplete and submit an attestation formfor free BinaxNOW point-of-care antigenCOVID-19 test kits (PDF) to request freeBinaxNOW COVID-19 point of care testkits. See revised PL 2020-49 (PDF) formore information. Tests are available whilesupplies last.42

COVID-19 Vaccination OptionsHHSC and DSHS have published Longterm Care COVID-19 VaccinationOptions (PDF).The resource document providesCOVID-19 vaccination options to ALFs. Enroll as a Texas Vaccine Provider Partner with Vaccine Provider Contact local/regional health department orpharmacies Reach out to Vaccine.LTCF@dshs.texas.gov43

COVID-19 Vaccination in TexasDSHS vaccination gin card sharelink&:embed y&:isGuestRedirectFromVizportal y44

DSHS Vaccine ResourcesUpdated COVID-19 Vaccine Information: COVID-19 Vaccine Information COVID-19 Vaccine Frequently AskedQuestions (FAQs) COVID-19 Vaccine Allocations COVID-19 Vaccination Hub ProvidersUpdated Information for COVID-19Vaccination Providers: Information for COVID-19 VaccinationProviders COVID-19 Vaccine Provider FrequentlyAsked Questions COVID-19 Vaccine Provider Webinars45

Vaccine EligibilityAs of Monday, March 29,2021, everyone age 16 and older isnow eligible to receive a COVID-19vaccine in Texas.46

Texas Public HealthVaccine SchedulerVisit the DSHS Texas Public HealthVaccine Scheduler to sign up for theCOVID vaccine.Call (833) 832-7067 if you don’t haveinternet or need help signing up.Spanish language and other translatorsare available to help callers.47

Where to Get VaccinatedIf you’re eligible to get vaccinated now, you cancheck with a large vaccination hub and/or a localvaccine provider, like a nearby pharmacy or yourdoctor.Find Vaccine:1. LARGE VACCINATION HUBS2. VACCINE AVAILABILITY MAP3. LIST OF ALL PROVIDERSWhen searching for a vaccination site, remember: Vaccine supply is limited. Not all local providershave vaccine each week and hubs may have longwaiting lists. Do not show up at a hub or provider looking for avaccine. Instead, check the provider’s website. Call only ifthe website doesn’t answer your questions.48

Authorized andRecommended VaccinesThe CDC provides information on whois and is not recommended to receiveeach vaccine and what to expect aftervaccination, as well as ingredients,safety, and ncov/vaccines/keythingstoknow.htmlCurrently, three vaccines areauthorized and recommended toprevent COVID-19: Pfizer Moderna Janssen49

Vaccine Allergic ReactionThe CDC provides recommendations onwhat to do if you experience an allergicreaction after getting a COVID-19vaccination. It also providesrecommendations for people who havehad allergic reactions to other vaccinesand for those with other types cov/vaccines/safety/allergicreaction.html50

Management of Anaphylaxisafter COVID-19 VaccinationCDC - Interim Considerations:Preparing for the Potential Managementof Anaphylaxis after COVID-19VaccinationThese interim considerations providerecommendations on assessment andmanagement of anaphylaxis followingCOVID-19 vaccination.51

Reporting Vaccine ReactionsThe Vaccine Adverse Event ReportingSystem (VAERS) is co-managed by theCDC and the FDA. VAERS accepts andanalyzes reports of adverse events(possible side effects) followingvaccination.Use VAERS to report adverse reactionsto the COVID vaccine, which are veryrare.VAERS52

Vaccine ResourcesQuestions related to the Pharmacy Partnershipfor LTC Program: eocevent494@cdc.govCDC webpage for the Pharmacy Partnership forLTC Program with FAQs for ngterm-care/pharmacy-partnerships.htmlQuestions regarding COVID-19 vaccineregistration can be sent to COVID-19Registration Support: Email: COVID19VacEnroll@dshs.texas.gov Toll-Free: (877) 835-775053

CDC Vaccination ToolkitLong-Term Care Facility Toolkit:Preparing for COVID-19 Vaccination atYour FacilityThis toolkit outlines the importance ofCOVID-19 vaccination in LTCFs,provides strategies for encouragingCOVID-19 vaccination, and includestools a facility may use to monitorCOVID-19 vaccination side effectsamong staff and residents.54

COVID-19 Vaccine FAQLTCR Publishes COVID-19 VaccineFAQsHHSC Long-term Care Regulation haspublished COVID-19 Vaccine FrequentlyAsked Questions (PDF).The resource document answerscommonly asked questions about theCOVID-19 vaccine.55

Texas COVID-19 Case Countand Vaccination data Vaccination Reports Case Data State-Reported Case Counts Provider-Reported Case Counts LTC Facility Visitation Requests Impact on Vulnerable Populations56

Public Health RegionsMap and contact info for all of thestate’s Public Health .shtm57

Provider Letters PL 20-37 Reporting Guidance for Long-TermCare Providers (Revised) PL 20-42 COVID-19 Response – Expansion ofReopening Visitation (replaced by PL 2021-12on 3/26) PL 20-46 Reporting Guidance for Long-TermCare Providers – Point-of-Care Antigen Testing(Revised) PL 20-48 Transferring COVID-19 PositiveResidents PL 20-49 Process to Request Free COVID-19Point of Care Antigen Test Kits – Rev. 3/2558

Provider Letters PL 20-50 Influenza (Flu) Vaccine Guidanceduring COVID-19 PL 20-53 Guidance for Activities, Dining, andVolunteers PL 21-01 COVID-19 Vaccination Reporting PL 21-04 HHSC COVID-19 Reporting Process PL 21-06 LTCR Waivers During Severe WinterWeather PL 21-12 COVID-19 Response – Expansionof Reopening Visitation59

Webinar Recordings and PDFsAccess recordings and PDFs of previousALF webinars from the ALF Portal.Click on COVID-19 Resources toexpand the accordion to accessresources and webinars. April 21, 2021 – ALF COVID-19 Q&AWebinar Slides (PDF) April 21, 2021 – ALF COVID-19 Q&AWebinar Recording60

GovDeliveryTo sign-up for Alerts: Go /subscriber/new Enter your email address. Confirm your email address, select yourdelivery preference, and submit apassword if you want one. Select your topics. When done click “Submit.”61

LTC OmbudsmanPatty DucayetState Long-term Care OmbudsmanTelework Phone: (737) 704-9075https://apps.hhs.texas.gov/news info/ombudsman/Statewide Contact for an LTC Ombudsman:Phone: (800) 252-2412 orEmail: ltc.ombudsman@hhs.texas.govFacebook Live EventsWeekly Facebook Live Q&A for Families of LTCResidents:Every Wednesday, 12:15 to ef ts

LTC OmbudsmanOmbudsman Concerns: Vaccination Status of Residents Residents must be treated withrespect and dignity, not separated ortreated differently by vaccinationstatus. Vaccination Status of Visitors - Avisitor is not required to inform youof their vaccination status. Whethera visitor is vaccinated or not does notaffect their visitation.

FAQ

How to ContactJennifer Morrison, ManagerJennifer.morrison@hhs.texas.govLTCR Policy MailboxLTCRPolicy@hhs.texas.govCOVID-19 rus-covid-19ALF Provider ing-facilities-alf65

Thank you!66

resume. administering the Johnson & Johnson/Janssen COVID-19 vaccine following the. recommendation from the CDC and FDA. More info: DSHS News Release Frequently Asked Questions Johnson & Johnson Safety Information Updated Johnson & Johnson EUA Fact Sheet for Recipients and Caregivers. 6

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