COVID-19 Office Procedures Update

Coronavirus pandemic announcements in white bold letters on an orange background

The North Country Center for Independence is currently open by appointment only. To schedule an appointment, please consult the staff contact list on our About page and either send an email or call the appropriate staff member. If you aren’t sure which staff member to contact you can also call our general phone line at 518-563-9058. Anyone visiting the Center by appointment will be required to wear a mask while in the building. Our staff can do home visits too, so feel free to ask.

Getting COVID-19 Vaccinations At Home

COVID-19 Vaccination at home for those who need it - contact information for North country counties

From the New York State Department of Health COVID-19 Website:
https://covid19vaccine.health.ny.gov/distribution-vaccine

“Vaccinating all New Yorkers is essential to restarting our economy and defeating this virus once and for all. But not everyone is able to travel to one of the many sites that are offering COVID-19 vaccines.

New York State, in partnership with counties, established local points of contact to expand access to vaccines through an in-home vaccination program for those who are homebound due to physical limitations, cognitive impairment, other chronic conditions, a lack of transportation, and/or visual impairments, and who do not have access to supports that may help them physically go to an existing vaccination provider.

If you're interested in getting vaccinated in your home, please reach out to the appropriate contact below.”

Clinton County - 518-566-4848
Website: www.clintonhealth.org

Essex County - 518-873-3500
Email: Covid19@essexcountyny.org
Website: www.co.essex.ny.us/Health/make-an-appointment/

Franklin County - 518-481-1111
Email: eoccallcenter@franklincony.org

2021 COVID-19 Links & Updates

COVID-19 Coronavirus Information

Updated: October 16, 2021

These links are for informational purposes only. You should always exercise your own judgement and consult medical, legal, or financial professionals as needed.

News & Official Announcements

Disability Organization Statements

Accessible Information and Instructions

Editorials and Opinions

Practical Information

Legal and Financial

Tips On Getting Vaccinated For COVID-19

Coronavirus pandemc announcements in white letters on an orange background

As of Monday, February 15, 2021, people with certain disabilities and chronic health conditions or “comorbidities” in New York State are eligible to make an appointment for COVID-19 vaccination. Here are some tips for what to expect when you are making an appointment.

Note: These are just informal suggestions based on direct experience, and they may change as the situation and delivery systems change over time. When something new comes up, this post will be updated.

Click here to make a vaccine appointment in New York State

Updated March 21:

List of local North Country vaccination sites, and phone numbers to call in Clinton, Essex, and Franklin Counties for more information.

Updated March 12:

If you have a disability that makes it difficult or impossible to leave your home to get a vaccine, contact your county health department now about a new vaccination at home effort.

Updated March 9:

From the Governor’s Office via the North Country Chamber of Commerce:

New Yorkers aged 60 and over, AND ADDITIONAL ESSENTIAL WORKERS WILL BE ELIGIBLE TO RECEIVE COVID-19 VACCINE …

  • New Yorkers 60+ Can Be Vaccinated Beginning March 10

  • Government Employees, Nonprofit Workers and Essential Building Service Workers Are Eligible for COVID-19 Vaccine Beginning March 17

  • Vaccine Distribution Eligibility Expanded; All Providers Except Pharmacies Can Now Vaccinate Any Eligible New Yorker Starting March 17

  • Pharmacies Can Vaccinate 60+ and Teachers Per Federal Guidance Starting March 10

Updated March 8:

From the NYS Health Department via the NYS Commision for the Blind …

To determine eligibility and schedule an appointment for a COVID-19 vaccination at a New York State operated vaccination site:

For help with finding transportation to the vaccination site, please call 211.

If you would like to schedule a vaccination appointment at a site other than a New York State operated site, such as a pharmacy, hospital, or other location, please contact that site directly.

Updated March 5:

Click here for a Press-Republican listing of local vaccination sites, registration links, and phone numbers for help.

Updated March 3:

Plattsburgh Press-Republican: “Appointments available at multiple vaccine clinics.”

These are specifically for people 65 and older. If your eligibility is by pre-existing chronic illness or health condition, not age, continue to use the NYS website to make an appointment, using the centered link above.

Updated March 1:

Information from the U.S. Centers for Disease Control, (CDC) …

Updated February 28:

If you made an appointment but you have a very long wait for it, you can go through the scheduling process again to see if there are sooner dates available. If there are, you can make a new appointment and cancel the old one. You can do this on the website, or call 833-697-4829.

Udated February 26:

Washington Post article: How to master the vaccine-appointment website: A guide for everyone

General Tips

  • You may be eligible if you have a disability or chronic health condition that is on this list, contact your doctor if you aren’t sure whether or not you are eligible. However, a doctor’s letter should not be necessary.

  • To register online, use the Google Chrome browser. Using a different browser may create technical glitches that prevent you from completing your registration.

  • For online registration, start at this website: https://am-i-eligible.covid19vaccine.health.ny.gov

  • If you don’t have internet access, or you just prefer to register over the phone, call 833-697-4829. You may be on hold for awhile, but you will end up talking to a person who will complete your registration with you personally over the phone.

  • If you have health insurance, whether private, Medicaid, or Medicare, make sure to have your insurance ID number handy because the registration process will ask for it.

  • You will be asked if you need “handicap accessible” features. If you say “yes” there’s a space to write exactly what you need for the vaccination site to be accessible to you.

  • Availability seems to change a lot, even during the same day. So you might want to check for availability a few times to see if you can get a better date. But if the open dates keep getting further away, go ahead and get the best appointment you can manage.

  • You can also try vaccination sites that are further away from you, if you are able to get to them.

  • Overall impression: The registration process doesn’t take too much time. But give yourself plenty of time in case you run into problems. Get a cup of coffee and settle in for a bit of a project.

One more thing ...

If you need a little more motivation to keep at it and get your COVID-19 vaccinations, check out these daily updated maps where you can find the current risk in any county in the U.S. As of the date of this post, Clinton, Essex, and Franklin Counties New York are all at “Very High Risk.” Infection and hospitalization rates are slowly going down, but COVID-19 is still dangerous in our area, especially for people with disabilities and chronic health conditions.

Personal Assistants and COVID-19 Vaccines

Consumer directed personal assistance - self-directed home care for people with disabilities

CDPAP Personal Assistants are now eligible to get the COVID-19 vaccine!

NCCI has provided all CDPAP Personal Assistants with a letter that verifies they are eligible to receive the COVID-19 vaccine right away. To prove they are eligible, they may be required to produce:

1) The verification letter

2) Your most recent pay stub

3) A photo ID.

Different vaccination sites and providers could handle this differently, so it is best to be prepared with all three items if you can. To find out where to get the vaccine, Personal Assistants can use one of these two approaches:

1. ONLINE PRE-SCREENING AND SCHEDULING

To use a state pre-screening tool, go to: https://am-i-eligible.covid19vaccine.health.ny.gov/Public/prescreener

2. CONTACT YOUR COUNTY PUBLIC HEALTH DEPARTMENT

Here are the Public Health phone numbers by county:

Clinton: 518-565-4840 or email health@clintoncountygov.com

Essex: 518-873-3500

Franklin: 518-481-1709 or email FCHealth@franklincony.org

Action Alert - The Senate’s New Coronavirus Relief Package

Acton Alert in large white letters on a deep red background

From the Center for Public Representation:

“The Senate has released a new coronavirus relief package, the HEALS Act. Unlike the HEROES Act passed by the House in May, the bill fails to address the disability community’s most urgent priorities, including additional funding for home and community based services (HCBS), which is desperately needed to help people with disabilities stay in their own homes and out of congregate settings, where they face a higher risk of infection and death from COVID-19 ... “

There are more issues with the Senate bill, with specific impacts on people with disabilities. Click here for the complete Action Alert.

And for more information on why Home and Community Based Services are and why they are important, click here for a Fact Sheet on HCBS and COVID-19 from the Center for Public Representation.

How you can help

Click here for notes and suggestions on taking action.

COVID-19 Reopening Plan

Coronavirus Pandemic announcements

The NCCI office is open to the public on a limited basis and by appointment only. COVID-19 screening and face coverings are required. Bathrooms will not be available to the public. This is our reopening plan, approved by the NCCI Board of Directors:

Name of Business: North Country Center for Independence
Address: 80 Sharron Evenue, Plattsburgh, NY 12903
Contact: 518-563-9058 (phone), 518-563-0292 (fax) www.nccci-online.com  
Executive Director: Robert Poulin
Covid-19 Safety Officer: Pam Moser

I. Office Protocols

Physical Distancing:

1. NCCI will always require staff and visitors to maintain a 6 ft. distance between each other.

2. Tightly confined spaces will be occupied by only one individual at a time.

3. NCCI will post social distancing markers using tape or signs that denote 6 ft. of spacing in commonly used and other applicable areas on the site. 

4. NCCI will limit in-person gatherings as much as possible and use tele-or video conference as an alternative. Essential in-person gatherings (e.g. meetings) should be held in open, well-ventilated spaces with appropriate social distancing and all participants wearing face coverings. All face-to-face meetings must be approved by the executive/assistant director. All participants must be screened as outlined below before the meeting.

5. All NCCI staff and visitors will be required to wear face coverings in all public areas of the office. Staff may only remove their masks while in their own offices and must have the door closed if they are working without a mask.

6. If a staff members duties and assignment allow them to work effectively from home, they will be encouraged to work remotely.

II. Personal Protective Equipment

A. Personal Protective Equipment (PPE): To ensure employees comply with protective equipment requirements, NCCI agrees to do the following:

1. NCCI will provide employees with a CDC recommended face covering at no cost to employees.

2. NCCI will maintain an adequate supply of coverings in case of replacement needs. 

3. NCCI will provide each employee with 4 CDC recommended washable face masks and additional disposable masks to give to visitors. 

4. Face coverings must be cleaned or replaced after use or when damaged or soiled, may not be shared, and should be properly stored or discarded. 

5. Staff will be required to review approved PPE training videos on proper use of personal protective equipment.

6. Employees will limit the sharing of objects and discourage touching of shared surfaces; or, when in contact with shared objects or frequently touched areas, wear gloves and will sanitize/wash hands and objects before and after use. 

a. Shared printers will be sanitized regularly with approved disinfecting wipes.

b. Door handles, knobs, faucets, and other shared surfaces will be disinfected regularly.

B. Hygiene and Cleaning: To ensure employees comply with hygiene and cleaning requirements NCCI agrees to do the following:

1. Adhere to hygiene and sanitation requirements from the Centers for Disease Control and Prevention (CDC) and Department of Health (DOH) and maintain cleaning logs on site that document the date, time, and scope of cleaning. The Sanitation Log will be maintained by staff in the office and all employees will share equally in the responsibilities of both sanitizing and recording the sanitation log.  The Log will be kept next to the main copier.

2. NCCI will provide and maintain hand hygiene stations for personnel, including handwashing with soap, water and paper towels or an alcohol-based hand sanitizer containing 60% or more alcohol for areas where hand washing is not feasible. 

3. NCCI will provide mobile “sanitation stations” for employees who work in the field with consumers. The stations will include plastic totes, sanitized cloths/wipes, bleach solution or other disinfectants, and will be used to disinfect all equipment that is passed between employees and participants before, during, and after appointments. 

4. NCCI employees in all locations will conduct regular cleaning and disinfection at least daily, or more frequently as needed and frequent cleaning of shared objects and surfaces, as well as high transit areas, such as restrooms and common areas must be completed. 

5. NCCI’s staff Janitor will thoroughly clean/disinfect the office twice a week.

6. NCCI will provide cleaning supplies recommended by the DOH and CDC as well as the safety data sheets for those products identified as effective against COVID-19.

C. Communication: To ensure the business and its employees comply with communication requirements, NCCI agrees to do the following:

1. Post signage throughout the site to remind personnel to adhere to proper hygiene, social distancing rules, appropriate use of PPE, and cleaning and disinfecting protocols. 

2. Establish a communication plan for employees, visitors, and consumers with a consistent means to provide updated information. 

3. Maintain a continuous log of every person, including staff and visitors, who enter the building. The log will include full name and a contact number. The log will be kept confidential and used only if requested by government assigned contact tracers. 

4. NCCI staff working in the field must maintain a log of the places they have been and when possible names and numbers of people they come in contact with.

5. If a worker tests positive for COVID-19, NCCI must immediately notify state and local health departments and cooperate with contact tracing efforts, including notification of potential contacts, such as all staff and visitors who had close contact with the individual, while maintaining confidentiality required by state and federal law and regulations.  The Executive/Assistant Director will be responsible for notifying state and local health departments. 

6. Visitors, such as delivery drivers, who are wearing proper PPE and are in the building for less than 5 minutes, do not need to be logged by name or screened.

III. Screening Protocol: 

A. Screening: To ensure the business and its employees comply with health requirements NCCI agrees to do the following: 

1. Implement mandatory health screening assessments (e.g. questionnaire and temperature checks) before employees begin work each day and for visitors. The Questionnaire shall ask about (1) COVID-19 Symptoms in the past 14 days, (2) positive COVID-19 test in past 14 days, and/or (3) close contact with confirmed or suspected COVID-19 case in past 14 days. Assessment responses must be reviewed every day and such review must be documented in case notes.

2. Field staff will contact each consumer via telephone prior to leaving for the appointment to perform the screening. Employees will be provided with a screening/assessment recommended by the DOH/CDC. 

3. To protect essential office staff, staff who conduct home visits or enter a nursing facility and or congregate home in the course of their field work, will not be permitted in the office for 14 days. Field workers are cleared to work from home and will be provided with all of the tools necessary to work remotely.

B. Contact tracing and disinfection of contaminated areas:  To ensure the business and its employees comply with contact tracing and disinfection requirements, NCCI agrees to do the following: 

1. Have a plan for cleaning, disinfection, and contact tracing in the event of a positive case. In the event of an employee testing positive for COVID-19, NCCI will disinfect the workplace using a product approved by the DOH/CDC that is effective for COVID-19. These cleaning products will be procured from NYSPSP if possible and kept on site for use as needed. 

2. If an employee tests positive for COVID-19, NCCI’s Executive/Assistant Director will request the employee’s logbook to help contact tracers identify those who were in contact with the employee. NCCI will report the information to the state and local Departments of Health.

IV. Office Capacity and Protocols

A. Capacity

1. There shall only be 6 employees in the office at any given time. This is 37% of total office capacity.

2. Only 2 visitors may be admitted to the office at one time. This will raise the office to 50% capacity.

3. Visitors, including delivery drivers will be directed to the outside door of the conference room where they will undergo required screening before being admitted (delivery drivers do not need to be screened as long as they are using proper PPE).

4. Visitors will not be allowed beyond the conference room for any reasons. Bathrooms are closed to the public and may only be used by staff.

5. All incoming visitors must wear masks. If a visitor does not have a mask, a disposable mask will be available in the conference room. Anyone refusing to wear a mask may not enter the building. If someone is unable to wear a mask for health reason, this requirement may be waved by the executive/assistant director. In such an event, staff working with that induvial should also wear a face shield, provided by NCCI, foor additional protection.

6. All tables, chairs, and items must be disinfected after a visitor leaves the building. A log will be kept with information about each visit and confirmation of the room being disinfected.

7. Monday, Tuesday, and Wednesday morning, the office will be reserved for CDPAP and admin staff only. A sign up list for office hours will be maintained on Teams for staff wanting office hours on Wednesday afternoon, Thursday, and Friday. Staff who are able to work remotely without compromising their effectiveness are encouraged to do so.

B. Bathrooms and Kitchen

1. The bathroom closest to the front lobby will be designated as bathroom A and the rear washroom will be bathroom B. Each day staff will be assigned a bathroom that they must use the rest of the day.

2. Staff must wipe down all surfaces that they touched while in the bathroom after every use.

3. A log will be kept by the printer that must be checked off after every wipe down of a bathroom.

4. Staff must also wipe down touched surfaces in the kitchen after every use. They must note that surfaces in the kitchen have been cleaned in a log book kept by the printer, after every use.

V. Reopening Timeline

1. As a “Phase Two” industry, NCCI is exercising abundant caution and plans to reopen its office on a limited basis during the first week of August if Covid-19 cases remain low in the community. NCCI has continued to provide services throughout the pandemic and is well positioned to maintain a low risk profile. As an agency that employs and serves people with disabilities, it is critical that NCCI continues to limit the chance of exposure and spread throughout the disability community. This plan is intended to remain in affect until the threat of Covid 19 has been substantially reduced (a vaccine is widely available). In the event of a community outbreak and government ordered shutdown, NCCI would return to a strict remote work policy with only ‘essential staff’ allowed to access the office building. 

2. NCCI will continue to consult the NY Forward website at https://forward.ny.gov/ and applicable Executive Orders at https://www.governor.ny.gov/executiveorders on a periodic basis or whenever notified of the availability of new guidance. 

New COVID-19 Policies for New York State Nursing Homes

Coronavirus pandemic announcements

The NCCI Long Term Care Ombudsman program received the following email detailing an Executive Order from Governor Cuomo regarding nursing homes and the COVID-19 pandemic:


Good morning everyone. Below is a summary from Lindsay Heckler regarding the Executive Order Issued this weekend by Governor Cuomo related to staff being tested and nursing homes no longer being required to accept COVID Positive residents. This is a move in the right direction to help slow down the spread in nursing homes and protect the residents.

Lindsay’s Summary:

Here is the executive order the Governor issued yesterday: https://www.governor.ny.gov/news/no-20230-continuing-temporary-suspension-and-modification-laws-relating-disaster-emergency

It’s pretty straightforward and I’ve copy pasted the below with emphasis. In short: every nursing home and adult care facility is required to test (or arrange to have tested) all staff twice a week, pursuant to a plan the administrator must develop / file with DOH by 5pm this Weds (5/11). Staff who refuse to be tested shall not be allowed to work. In addition, by Friday, facilities must certify they are in compliance. The DOH has the authority to revoke / suspend a facilities (nursing home and adult care facility) operating certificate and appoint a receiver on 24 hours notice. Nursing homes and adult care facilities face $2k up to $10k per day per violation penalty for noncompliance.

Lastly, the E.O. states hospitals shall not discharge a patient to a nursing home unless the nursing home operator or administrator has first certified that it is able to properly care for such a patient. In addition, hospitals shall not discharge a patient to a nursing home without first performing and obtaining a COVID negative test.

Based on the E.O it would be my understanding that no one should be admitted to nursing homes that are in IJ status …

The following is in effect through June 9th:

•  Clause (b) of subparagraph (v) of paragraph (1) of subdivision (c) of section 415.26 , paragraph (8) of subdivision (a) of section 487.9 and paragraph (5) of subdivision (a) of section 488.9 of Title 18 of the NYCRR; and subdivision (7) of section 4656 of the Public Health Law are modified to the extent necessary to require that the operator and administrator of all nursing homes and all adult care facilities, including all adult homes, enriched housing programs and assisted living residences to test or make arrangements for the testing of all personnel, including all employees, contract staff, medical staff, operators and administrators, for COVID-19, twice per week, pursuant to a plan developed by the facility administrator and filed with the Department of Health no later than 5:00 p.m. on Wednesday, May 13, 2020.

Any positive test result shall be reported to the Department of Health by of the day following receipt of such test result 5:00 p.m., in a manner determined by the Commissioner of Health. Nothing herein shall prohibit staff of the Department of Health, or the local health department in the jurisdiction of the nursing home or adult care facility, from having unrestricted access to the facility where such access is determined necessary in the discretion of the Commissioner of Health for purposes of testing all personnel for COVID-19, and provided further that in such circumstances the operator and administrator shall cooperate fully with Department of Health and local health department staff to facilitate such testing.

•  No later than May 15, 2020  both the operator and the administrator of all nursing homes and adult care facilities must provide to the Department of Health a certification of compliance with this Executive Order and directives of the Commissioner of Health, and all other applicable Executive Orders and directives of the Commissioner of Health.

•  The Commissioner of Health is authorized to suspend or revoke the operating certificate of any nursing home or adult care facility if it is determined that such facility has not complied with this Executive Order, or any regulations or directives issued by the Commissioner of Health, and if determined to not be in compliance, notwithstanding any law to the contrary the Commissioner may appoint a receiver to continue the operations on 24 hours’ notice to the current operator, in order to preserve the life, health and safety of the people of the State of New York. Any false statement in the attestation shall be punishable under the provisions of Penal Code 210.45.

•  Any nursing home or adult care facility which does not comply with this Executive Order shall be subject to a penalty for non-compliance of $2,000 per violation per day, as if it were a violation of section 12 of the public health law, and any subsequent violation shall be punishable as if it is a violation of section 12-b of the public health law, with a penalty of $10,000 per violation per day.Any personnel of a nursing home or adult care facility who refuse to be tested for COVID-19 pursuant to a plan submitted to the Department of Health shall be considered to have outdated or incomplete health assessments and shall therefore be prohibited from providing services to such nursing home or adult care facility until such testing is performed.

•  Any article 28 general hospital shall not discharge a patient to a nursing home, unless the nursing home operator or administrator has first certified that it is able to properly care for such patient. Provided further, that any article 28 general hospital shall not discharge a patient to a nursing home, without first performing a diagnostic test for COVID-19 and obtaining a negative result.

Claudette Royal
New York State Ombudsman
Office of the State Long Term Care Ombudsman
2 Empire State Plaza, 5th Floor, Albany, NY 12223-1251
(518)  473-8718 | Claudette.Royal@aging.ny.gov
www.aging.ny.gov 

Keep Up To Date On The Pandemic In The North Country

Coronavirus pandemic announcements

If you are looking for updated information online about how the COVID-19 pandemic is affecting the North Country, here are two good resources:

North Country COVID-19 Tracker

County by county numbers of confirmed COVID-19 cases, recoveries, and deaths, updated daily.

North Country Public Radio COVID-19 Coverage

All the local media are covering the pandemic, but NCPR has an especially good page with information for the region, including the “Daily Coronavirus Blog,” where up to the minute developments are reported.

As people with disabilities in the North Country move into the next phase of the pandemic, and we all make decisions about gradually getting back to normal life while protecting ourselves and the community, these are good sources of hard data — mostly free of panic, over-optimism, or political posturing.

COVID-19 Guidance for the Authorization of Community Based Long-Term Services and Supports Covered by Medicaid

Coronavirus Pandemic Announcements
DOH COVID19 Guidance on Health Assessments 1.jpg
DOH COVID19 Guidance on Health Assessments 2.jpg
DOH COVID19 Guidance on Health Assessments 3.jpg
DOH COVID19 Guidance on Health Assessments 4.jpg

Text of the above pictured letter:

March 18, 2020

Re: COVID-19 Guidance for the Authorization of Community Based Long-Term Services and Supports Covered by Medicaid

The New York State Department of Health (NYSDOH) is providing this guidance to Medicaid Managed Care Plans, Local Departments of Social Services (LDSS), and Consumer Directed Personal Assistance Program (CDPAP) pertaining to the current novel coronavirus (COVID-19) outbreak. The guidance applies to Medicaid covered services as described below when delivered through either Licensed Home Health Care Services Agencies or CDPAP. Topics include: (1) physician orders; (2) the initial Community Health Assessment; (3) Community Health Reassessments; (4) Annual Health Assessments for Personal Assistants; and (5) Facility-Based Assessments. Guidance provided herein should be shared by CDPAP Fiscal Intermediaries with Consumers and by Consumers with their Personal Assistants. This guidance is provided in light of the COVID-19 outbreak and the state disaster emergency declared by Executive Order No. 202 and shall remain in effect until subsequent notice from the NYSDOH which will be provided prior to or upon the expiration of such state disaster emergency.

Background

The health and safety of the State’s health care workforce and our ability to provide and support patient care remain our priorities. Recently, community-wide transmission of COVID-19 has occurred in the United States (US), and the number of both Persons Under Investigation (PUIs) and confirmed cases are increasing in NYS. The situation with COVID-19 infections identified in the US continues to evolve and is very rapidly changing. It is important for all agencies, Medicaid Managed Care Plans, LDSS and Consumer Directed Personal Assistance Program (CDPAP) consumers keep apprised of current guidance by regularly visiting the Centers for Disease Control and Prevention (CDC) and NYSDOH websites, as well as the NYSDOH Health Commerce System (HCS), for the most up-to-date information for healthcare providers.

CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html
NYSDOH: https://www.health.ny.gov/diseases/communicable/coronavirus HCS: https://commerce.health.state.ny.us

It is important to keep staff, enrollees, and Consumers updated as the situation changes and educate them about the disease, its signs and symptoms, and necessary infection control to protect themselves and the people they serve. NYSDOH distributes alerts and advisories on its website and, therefore, it is vital that all organizations maintain up-to- date contact with both the CDC and NYSDOH. Additionally, Medicaid Managed Care Plans, LDSS and CDPAP Consumers may wish to provide internal contact information for their staff, enrollees and Consumers, as applicable, to call with concerns, reports or questions.

Guidance

1. Physician Order:/Initial authorizations for Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS) will continue to require a physician order. Pursuant to applicable state regulations, the physician’s order documents the medical examination that assess an individual’s needs for PCS or CDPAS and describes the patient’s medical condition and regimes and the patient’s need for assistance with personal services tasks. Based on this information, the physician must certify as part of the order that the patient is able be cared for at home. To promote compliance with CDC and NYSDOH guidance and avoid unnecessary exposure to COVID-19, effective immediately, and until further notice is provided by NYSDOH, the ordering physician is encouraged to use the telephone or permitted telehealth modalities in connection with completion of the required physician order. Physicians should consult with applicable provisions of NYSDOH’s recently issued special guidance on the use of telehealth for a description of permitted telehealth modalities (https://www.health.ny.gov/health_care/medicaid/program/update/2019/2019- 02_speced.htm).

2. Initial Community Health Assessment/: Initial authorizations for PCS, CDPAS, and other community based long term services and supports (CBLTSS) (i.e., nursing services in the home, therapies in the home, home health aide services, adult day health care, and private duty nursing) and requests for changes in service authorizations, will continue to require a completed Community Health Assessment (CHA). To promote compliance with CDC and NYSDOH guidance and avoid unnecessary exposure to COVID-19, effective immediately, and until further notice is provided by NYSDOH, registered nurses may conduct the CHA by telephone or permitted telehealth modalities, as described in the applicable provisions of the Telehealth Guidance. During this time period, CHAs conducted by telephone or telehealth, which would otherwise require a face-to-face assessment to be fully completed, may be used to develop an initial plan of care for the recipient and to authorize necessary CBLTSS, both through fee-for-service and Medicaid managed care.

Notwithstanding the ability to conduct a CHA by telephone or through telehealth, eligibility requirements and standards for services and Managed Long-Term Care (MLTC) plan enrollment are not being changed. To that end, a CHA conducted by telephonic or through telehealth, but that cannot be fully completed (e.g., the functional assessment) may not be used to determine initial eligibility for members to enroll in MLTC plans. Until such time as the CHA may be fully completed, the member’s LDSS will develop and monitor the plan of care. Additionally, this guidance does not preclude completion of a full CHA and enrollment in an MLTC if consistent with CDC and NYSDOH guidelines. For individuals already enrolled or newly enrolled in a Mainstream, HIV-SNP or HARP Medicaid Managed Care plan, the member’s plan will remain responsible for completing the CHA and monitoring the plan of care.

3. Reassessments and Home Visit:/Effective immediately, and until further notice, NYSDOH is suspending all required periodic re-assessments of CHAs through Medicaid managed care (including MLTC) or fee-for-service Medicaid. In addition, the six-month in-person care management home visit requirement is also suspended. CHAs and in-person care management home visits otherwise due, but not conducted under this suspension should be noted in the plan of care and care management records for audit purposes.

4. Personal Assistant Annual Assessments./Effective immediately, and until further notice, to ensure continuity of care for individuals receiving PCS through CDPAP, NYSDOH is suspending the annual renewal of the health assessment, immunizations and TB test required for personal assistants providing services to Consumers in CDPAP. This suspension does not apply to new personal assistants. Renewals that do not occur as a result of this suspension should be documented in the employee’s record.

5. Facility-Based Assessments./When scheduling the CHA with a skilled nursing facility or other health care facility, LDSS and Conflict-Free Evaluation and Enrollment Center (CFEEC) staff must rely on the guidance and direction of facility medical director as to whether it is medically necessary for the individual to have a CHA evaluation. This guidance is consistent with Executive Order 202.1, which states only medically necessary visits will be allowed at skilled nursing facilities.

Guidance on Home Care Services and Close or Proximate Contacts

To help protect consumers and personal assistants, attached are two NYSDOH COVID-19 guidance documents related to home care services and close or proximate contact of a confirmed or suspected case of COVID-19. The links to those guidance documents are provided below:

* Interim Guidance for Home Care Services Regarding COVID-19 https://coronavirus.health.ny.gov/system/files/documents/2020/03/03-16- 20_home_care_services.pdf

* Guidance on the Contacts of a Close or Proximate Contact of a Confirmed or Suspected Case of COVID-19 https://coronavirus.health.ny.gov/system/files/documents/2020/03/contacts_of_contact s_guidance.pdf

Instructions for provider personnel who are at risk of being a Person Under Investigation (PUI)

Staff are exposed to the general community each day and could become infected with an acute respiratory illness (e.g. COVID-19, influenza, respiratory syncytial virus (RSV)), if community transmission of that illness is occurring. Providers should ensure they have a policy in place to speak with staff prior to them conducting face-to-face visits with enrolled members in order to screen the staff for symptoms or contacts that might have put them at risk. It is important that providers strictly enforce their illness and sick leave policies. Staff showing symptoms of illness should not be permitted to remain at work or visit members and should not return to work until completely recovered.

Staff who have been potentially exposed to someone with confirmed COVID-19, or to someone who is a person under investigation (PUI) for COVID-19, might be placed under movement restrictions by public health officials/,/based on exposure risk for having contracted COVID-19 and any presenting symptoms.

If a staff person is found to be ill upon screening, the agency should send the person home and suggest that they contact their primary care physician immediately or refer them to immediate medical care, if indicated.

Where can I direct my questions about COVID-19?

Questions can be directed to the following email address: icp@health.ny.gov; or to the toll-free call center at 888-364-3065.
Your diligence in implementing appropriate measures for COVID-19 preparedness is appreciated.

Where can I direct my questions about this guidance?

Please send any questions relating to this guidance to MLTCinfo@health.ny.gov.

Your diligence in implementing appropriate measures for COVID-19 preparedness is appreciated.

Sincerely, Jonathan Bick, Director, Division of Health Plan Contracting and Oversight Office of Health Insurance Programs

Lana I. Earle, Director, Division of Long Term Care, Office of Health Insurance Programs