State Updates
Updates on Vaccine Administration
On December 9th, Governor Cuomo held a press conference during which he announced several updates regarding the State’s vaccine administration plan. The federal government will be distributing the vaccine to New York State and to New York City, but the State’s plan will drive allocations of both shipments. Nursing home residents and “high risk” hospital workers are prioritized for the initial allocation. The State will provide hospitals with guidance on high risk hospital workers, which will include emergency room workers, intensive care unit (ICU) staff, and pulmonary department staff. Hospitals will select workers within this guidance to receive the initial allocations of the vaccine.
The State has also opted into the federal Pharmacy Partnership for Long Term Care Program (here), in which CVS and Walgreens employees will vaccinate nursing home residents and staff in the facilities (similar to the process for the flu vaccine). Pending approvals, vaccinations are expected to begin around December 21st. The State will be dedicating approximately half of the initial vaccine allocation to this program for nursing homes. Future allocations will ensure enough doses for all staff and residents.
The Pfizer vaccine is expected to be recommended for emergency authorization today by the Food and Drug Administration (FDA). Pending approval, the State expects to receive the initial allocation of 170,000 doses of the vaccine starting early next week, with further allocations arriving in the coming weeks.
The State has operationalized 90 regional distribution centers capable of adequate cold storage for the vaccine. These distribution centers will receive enough doses for approximately 90,000 patient-facing hospital staff (40 percent of total hospital patient-facing workforce statewide). Staff at every hospital, regardless of their own storage capabilities, will have access to the first allocation of the vaccine. The State expects that all designated high risk hospital employees will receive a vaccine, beginning two weeks after it is distributed to the State.
In subsequent distributions, vaccines will be prioritized for congregate care and other long-term staff and residents, followed by Emergency Medical Services (EMS) workers and other health care workers. Essential non-health care workers will next be prioritized for the vaccine followed by the general population, starting with those at highest risk. The State is establishing 10 regional vaccine distribution hubs or “control rooms” which are expected to coordinate with all health care providers in the region that can deliver or support the delivery of vaccines, including health systems, physician practices, FQHCs, and also community and faith-based organizations.
Governor Cuomo Issues Executive Order 202.80
On December 9th, Governor Cuomo signed Executive Order 202.80 (available here), which extends Executive Order 202.73 (available here) through January 8, 2021. Executive Order 202.73 modifies provisions contained in Executive Order 202.40 (available here) to require nursing homes located in designated red, orange, or yellow cluster zones to test or make arrangements for the testing of all personnel, including all employees, contract staff, medical staff, operators, and administrators for COVID-19 in accordance with Department of Health guidance here. Such testing must occur twice per week in all nursing homes in red, orange, and yellow zones until the facility is no longer in a designated zone, at which time the facility may revert back to once weekly testing. Each nursing home will have seven days from the date of the zone designation to be in full compliance with the twice weekly testing.
Commissioner Zucker Issues Letter to Hospitals and Nursing Homes Regarding Surge & Flex Data Reporting and PPE Requirements
On December 8th, New York State Health Commissioner Howard Zucker sent a letter to hospital and nursing home administrators outlining data reporting measures as part of the State’s “Surge & Flex” protocol. The letter notes that the State will continue to monitor hospital capacity through the Health Electronic Response Data System (HERDS) throughout the current COVID-19 surge, during which the State expects to see increasing case numbers and hospitalizations through at least mid-January 2021. When submitting HERDS data, hospitals should clearly flag when a critical situation is developing. Additionally, hospitals and hospital systems should alert the State regarding any issues or situations that arise prior to the hospital reaching 80 percent capacity (or 75 percent of the implemented surge capacity). As reported in the HERDS survey, reported capacity should specifically include:
- Total staffed operating beds
- Total staffed ICU beds
- Staff shortages
- Personal Protective Equipment (PPE)
- Any critical patient care equipment
Hospitals that are not part of a hospital system are required as part of their surge plan to develop and have in place appropriate arrangements with neighboring hospitals to accommodate an increase in patient volume prior to a level that overwhelms their hospital capacity. Prior to transferring any patients to a partner hospital, a hospital should notify the State regarding the need to transfer and the location where the hospital is planning to send the patient so that the State can ensure adequate regional capacity. Hospital systems and individual hospitals that do not comply with the requirements of the Surge & Flex protocol or the Governor’s Executive Orders to monitor capacity and plan appropriately may be subject to significant penalties or license suspension or revocation.
As a reminder for PPE requirements, nursing homes are required to have a 60-day stockpile and hospitals a 90-day stockpile of all required PPE categories (gloves, gowns, face shields, goggles, surgical masks and N95), based upon peak usage in April. Facilities must have sufficient PPE for their day-to-day needs above and beyond the stockpile. The stockpile is only to be used in the event of an international shortage of PPE, as occurred last spring, in which case facilities will receive notification from DOH that the stockpile may be used. Facilities that are not compliant with stockpile requirements received deficiency notices from DOH last week.
The Commissioner’s letter is available here.
Updated Guidance Documents
The following New York State and City guidance documents have been recently released:
- Post-COVID Care Clinics (12.7.20)
- OMH Updates on Infection Control: Residential Providers (12.2.20)
- OMH Updates on Infection Control: Ambulatory Providers (12.2.20)
Federal Updates
CMS Updates Acute Hospital Care at Home Program FAQs
On December 9th, the Centers for Medicare and Medicaid Services (CMS) updated the Acute Hospital Care at Home Program Frequently Asked Questions (FAQs) document. CMS announced the Acute Hospital Care at Home Program, which allows hospitals to apply for regulatory waivers of certain Hospital Conditions of Participation related to 24/7 nursing services, on November 25th. The updated FAQs provide a number of clarifications aspects of the program, including, but not limited to:
- Resources available to participating hospitals;
- Reporting requirements;
- Waiver application information; and,
- Information specific to aspects of acute care, including initial examinations, remote monitoring, in-person visits, billing and coding, and electronic health record documentation.
The FAQs are available here.