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Agency for Health Care Administration Secretary Mary Mayhew announces 19 long-term care facilities either tested positive or are suspected of having coronavirus. Image via the South Florida Sun-Sentinel.

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‘Standing guard’ against coronavirus: Mary Mayhew on Medicaid, nursing homes, and more

Don’t make this overly complicated.

Florida hospitals and nursing homes have been on the front lines in the ongoing battle against COVID-19.

The state Agency for Health Care Administration, which is led by Secretary Mary Mayhew, is usually best known for its oversight of the massive Medicaid program. But its role regulating hospitals and nursing homes has made Mayhew an integral part of Gov. Ron DeSantis’ team leading the state’s response to COVID-19, which is particularly dangerous to seniors and people with underlying health conditions.

At least 1,706 residents of long-term care facilities have been infected with COVID-19, according to the latest state data. Also, 1,637 long-term care staff members have been infected. More than 37 percent of the 1,539 COVID-19 deaths in the state stem from long-term care facilities.

Five questions for Mayhew:

Q: The state announced a new policy this week requiring nursing homes to transfer residents with confirmed or suspected cases of COVID-19 if the homes can’t meet isolation requirements. The policy comes as the number of infections at the facilities increases, as does the number of deaths. Why did you wait so long to come out with a definitive policy?

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MAYHEW: It’s not new. It is largely (federal Centers for Disease Control and Prevention) guidance that has been out there. The reason we are intensifying the focus on it, and I have been saying this from the very beginning, we have a number of skilled nursing facilities that, simply because of their physical plants, are challenged to provide the isolation that is needed to prevent the spread. We can’t have false expectations of these facilities.

This is a level of infection prevention and control that exceeds what has typically been expected of these facilities. The level of PPE (personal protective equipment) that is needed exceeds what these facilities have had. That is why the Division of Emergency Management is still focused on how to deploy masks and gowns and why the federal government is sending directly to long-term care facilities more PPE.

And it just bears repeating, this has been a huge challenge to raise awareness, to not create false expectations when you have older buildings or nursing homes that have semi-private rooms, given how vulnerable this population is to COVID-19 and how rapidly it can spread in those facilities.

And we’ve done a lot of work to stand guard. But I wanted, the Governor wanted, to amplify expectations around transfers, especially as hospitals begin to resume the provision of the critical health-care services that have been delayed or postponed.

We cannot lose sight of the importance of protecting our elderly and transferring, when appropriate, out of a long-term care facility, positive or suspected COVID-positive residents when the facility can’t meet that level of isolation and infection prevention control.

Q: Where will the nursing homes be transferring patients to?

MAYHEW: Hospitals are accepting these individuals, which is why the Governor sent the letter to Administrator Seema Verma at CMS (the federal Centers for Medicare and Medicaid Services).

In order to save lives, to prevent the spread in a residential setting, hospitals are admitting individuals who may not require hospital level of care. But they need isolation and a level of 24-7 clinical monitoring that may not be supported in the residential setting. But they don’t necessarily meet Medicare hospital admission criteria.

What we said (to CMS) is give them either some step-down hospital Medicare rate or a rehabilitation rate. But just do it. And do it in a very administratively streamlined process. Don’t make this overly complicated. You, CMS, have issued a lot of flexibilities. We just need you to understand how critically important this one is.

So much of the focus has been on preserving capacity in the hospital, anticipating that surge. But not really, from a federal perspective, the need to transfer out of those long-term care settings.

Q: A couple of weeks ago, nursing homes, doctors and hospitals asked DeSantis to use his executive authority and provide liability protection from lawsuits arising out of care that was delivered, or not delivered, during the COVID-19 pandemic. Do you support those requests?

MAYHEW: My personal opinion is not part of the equation here. I serve the Governor and we, together, are focused on how to best support our providers in caring for individuals with COVID. (The Governor’s office is) thoughtfully considering those requests.

Q: You lifted Medicaid prior-authorization requirements for mental health services and eliminated service limitations on mental-health and substance-use disorder treatment during this time. Do you envision extending those policies beyond COVID-19?

MAYHEW: We did that because we recognize that current and projected increased demand as individuals and families and children grapple with the stress and strain as a result of this public health crisis. That one clearly we need to continue to maintain, and we’ll have to monitor how long that makes sense to continue to support that level of access.

We understand how dramatic the disruption in people’s lives and its effect on mental health, mental illness and substance-use disorders. So those we will certainly work to continue for quite some time.

But in terms of some of the other flexibilities, we’re going through that process right now of (reviewing) what flexibilities might we need to continue and what’s the avenue for how we continue those outside of various executive orders.

We are absolutely looking at that. I’ll give you one example of an area where we may need to continue that flexibility which relates to alternative sites of care.

Some of that may have existed under the federal flexibility, but as we work to ensure that those (nursing home) transfers occur, we may need to continue to have some of that flexibility around those locations in order to promote the kind of isolation and clinical monitoring that will be critical for those frail elderly individuals or individuals with underlying medical conditions that are residents of long-term care settings.

We’ll be very strategic and thoughtful about the best appropriate settings, but we may need to retain some of that flexibility.

Q: Does that mean that the alternative facilities won’t need to be immediately licensed?

MAYHEW: It more pertains to, how can we streamline? What kind of virtual review can we conduct? How quickly can we support a streamlined onsite review? Just being flexible so that we don’t have unnecessary delay.

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Republished with permission of the News Service of Florida.

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