Safe and Calm DECEMBER 23, 2020

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Safe and Calm

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Agenda

1. Safe and Calm Holiday Schedule

2. Advocacy - Lame Duck Wrap Up

3. Vaccination and Mandating

◦ Elisa Lintemuth Member, Dykema

4. CRC Overview and Lessons Learned

◦ Dana M. Prince, PhD

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Holiday Webinar Schedule

December 25: Holiday

December 30: Tentative: we will hold the Safe and Calm Webinar if there is new relevant information and members are available considering the vaccine plan.

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2020 Legislature Wraps Up

The legislature wrapped up for the year after a special session on Monday

◦ Passed several bills

◦ Including a supplemental budget bill

A national COVID-19 relief package sent to the president’s desk The package does not have state budget relief in it

◦ Negotiated in a separate package

The bills I am about to talk about are not yet law. All of them are on the governor's desk waiting for her signature.

◦ Her team needs time to analysis the bills

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Budget Supplemental (

SB 748

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Presented to the governor yesterday afternoon

◦ She has spoken positively about the bill

$465 Million total

◦ $262 million being used to cover the temporary extension of unemployment benefits from 20 weeks to 26 weeks for Jan. 1, 2021 – April 1, 2021

$103.85 million for vaccination, testing and COVID-19 response efforts

$100.0 million to extend the $2.00 per hour direct care worker wage increase for an additional 2 months.

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Previously Mentioned Bills

Senate Bill 77 – Electronic Monitoring Bill

◦ Conversations with their team indicate that the governor is not a fan of the bill

◦ The governor's team did not say weather she will or won’t sign the bill

House Bill 4098 – Medication Aide Bill

◦ Governor has yet to comment on the legislation

◦ Passed along party lines

Senate Bill 1185 – Health Care Facility Legal immunity

◦ Governor has yet to comment on the legislation

◦ Took a lot to pass the last immunity bill

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Other bills on the governor's desk

House Bill 4910/4911 – Misrepresentation of Emotional Support Animals Act

◦ Creates more flexibilities for housing providers who are seeking more information regarding a support animal

◦ Passed with bipartisan support

Senate Bill 1021 – Creates license reciprocity for individuals educated in Canadian

◦ Passed by the full chamber

House Bill 4042 – Would add Michigan to the national nurse licensure compact

◦ A Michigan nursing license would be applicable in many other states and vice versa

◦ Passed with bipartisan support

House Bill 4491 – Would change the licensure requirements relating too “good moral character”

◦ Only felony's can be revied upon licensure application with some expectations

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Important Dates

12/31/2020 Deadline for the purchase or initialization of equipment paid for by the Nursing Facility Infection

Prevention Grants

1/31/2020 Estimated end date for the distribution of the 3rd round of PRF funds

2/1/2021 Deadline for SNFs to submit expenditure documentation of the Nursing Facility Infection

Prevention grant funds to MDHHS

2/28/20 End of the third reimbursement period for Direct Care Worker Wage Pass-through payments

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Questions

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www.dykema.com

Exceptional service. Dykema delivers.

COVID-19 Vaccines In the Workplace

Presented by Elisa Lintemuth

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Exceptional service. Dykema delivers. 11

Background on Mandatory Vaccine Programs

Various court decisions and guidance from the EEOC and OSHA

previously confirmed that employers can require employees to receive

vaccinations if:

• They are job-related and consistent with business necessity; and

• They allow for:

–

medical exemptions as required by the Americans with Disabilities

Act (“ADA”); and

–

religious objections under Title VII of the Civil Rights Act of 1964

(“Title VII”).

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ADA Accommodations

• Employees with a qualifying disability which prevents them from safely

receiving the vaccine may be entitled to an exemption from a mandatory

vaccine policy. Examples include:

– A serious allergy to any ingredient in the vaccine;

– A history of Guillain-Barré syndrome.

• Minor sensitivities and undocumented allergies are likely insufficient to

constitute a disability under the ADA.

• The EEOC has advised that employers should accommodate a pregnant

employee’s request to not to be vaccinated.

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Religious Objections

• If employees’ sincerely held religious beliefs or practices preclude them from receiving vaccinations, they may have a valid religious objection under Title VII.

• Their beliefs do not need to be “mainstream” beliefs of any organized religion.

• The EEOC considers religious practices to include sincerely held moral or ethical beliefs as to what is right and wrong.

• But political, medical, or intellectual beliefs opposing vaccinations do not entitle an individual to a religious exception.

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Accommodation Requests

• If an employee requests an accommodation, the employer should engage in the interactive process.

• An employer may deny a vaccine-exemption if it can prove that it would result in an “undue hardship.”

– Religious belief under Title VII = more than de minimis cost or burden

– Disability under the ADA = significant difficulty or expense

• An accommodation that would pose a direct safety threat to employees or third parties would amount to an undue hardship.

• Employers could require an employee to follow different protective measures as an accommodation.

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Recent EEOC Guidance

• On December 16, 2020, the EEOC issued updated guidance, confirming

that an employer can require the administration of any vaccine that has

been “approved or authorized” by the FDA, as long as it provides medical

and religious exemptions.

• Vaccination itself is not a medical examination under the ADA.

– But if an employer or the employer’s third-party contractor asks an employee pre-vaccination screening questions, those questions are likely

disability-related inquiries, which must be job-disability-related and consistent with business necessity under the ADA.

– To avoid these issues, employers could either: (1) offer vaccination on a

voluntary basis; or (2) require employees to show proof of vaccination from a third party that does not have a contract with the employer.

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Recent EEOC Guidance

• Employers should conduct an individualized assessment to determine whether an unvaccinated worker constitutes a “direct threat.”

• “The prevalence in the workplace of employees who already have received a

COVID-19 vaccination and the amount of contact with others, whose vaccination status could be unknown, may impact the undue hardship consideration.”

• If an employer cannot provide a reasonable accommodation, the EEOC has said “it would be lawful for the employer to exclude the employee from the

workplace.”

– However, the EEOC cautioned: “This does not mean the employer may

automatically terminate the worker. Employers will need to determine if any other rights apply under the EEO laws or other federal, state, and local

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Is COVID-19 Different?

YES!

• COVID-19 is more deadly than any other communicable disease

that modern workforces have faced.

• The first COVID-19 vaccines available will have only received

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Emergency Use Authorization

• The EUA process is a rigorous one, but it is not supported by the same long-term safety data required for typical FDA approval.

• The Pfizer and Moderna COVID-19 vaccines are the first vaccines authorized on an EUA basis that have been widely distributed.

• The EUA statute states: “individuals to whom the product is administered are [to be] informed of . . . the option to accept or refuse administration of the product, of the consequences, if any, of refusing administration of the product, and of the

alternatives to the product that are available and of their benefits and risks.” 21 U.S.C. § 360bbb-3(e)(1)(A)(ii).

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Practical Concerns

• Employers may find that employees may react poorly to a mandatory vaccine policy.

– A recent Gallup Poll shows that only 63% of Americans would agree to be vaccinated if an FDA-approved vaccine were available now.

– There is concern that the FDA has “fast-tracked” the vaccine and that it is not supported by long-term safety data.

– In Michigan, all Tier 1 automotive manufacturers and large hospital systems have reported that, at present, they are planning to encourage rather than mandate

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Practical Concerns

• Vaccine policies should be consistently enforced so that employees are treated like similarly situated employees.

– How will your company react if a number of key employees refuse vaccination without a valid exemption?

– Is your company willing to terminate employees who refuse to comply?

• There are reports of some individuals experiencing flu-like symptoms (fever, muscle pain, chills, and headaches) after the second injection.

– Should you stagger vaccination of key employees and employees within the same department?

– Will employees refuse the second injection once they hear from others who experienced a more severe response?

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Practical Concerns

• The threat of COVID-19 is higher in senior care facilities, as the mortality rate is much higher in the aged population.

• There will likely be a strong business case for vaccination if families look to place their loved ones in facilities with vaccinated workforces.

• But staffing shortages could increase if you require vaccination and your workers are unwilling to receive the vaccine.

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Practical Concerns

• Whether or not you mandate or encourage vaccination, offer employees a trusted resource to provide knowledgeable, science-based information.

• Consider whether you will provide employees with paid time off to get vaccinated.

• Consider whether you will require employees to use accrued leave for absences related to an adverse reaction.

• If you are a unionized employer, review your CBA to determine whether this is a permissive or mandatory subject of bargaining.

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Conclusion

–

There is not one right answer – what is right for each employer

depends on their industry, their workforce, and the impact of

COVID-19 on their business.

–

Your plan can change – e.g., encourage now and mandate later

after full FDA approval.

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Thank you!

Elisa Lintemuth 616.776.7532 [email protected]

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St. Ann’s

COVID-19

Care Recovery Center

(CRC):

Overview & Lessons Learned

December 2020 Executive Director Dana M. Prince, PhD

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St. Ann’s COVID-19 CRC

General Overview

Services: St. Ann’s is a not-for-profit Catholic organization offering Assisted Living,

Skilled Nursing, and Memory Care.

Opportunity: A designated Memory Care LTC, with 10 private rooms, was converted

to an internal COVID Care Care Unit (CCU).

Mission: Fulfills the mission of the Carmelite Sister’s – received Board support as the

services reached older adults in need in our community (as well as throughout the state).

Timing: Opened in April, with staff caring for internal COVID-positive residents until

August.

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Location: The unit is at the end of a clinical hallway,

separated by a fire door, which allows for physical

isolation from all residents

• Two exterior doors (1 for entry, 1 for exit)

• One interior door (used to deliver meals and

supplies – no staff allowed to enter/exit)

• Staff restroom, kitchenette, storage, and

workspaces

St. Ann’s COVID-19 CRC

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St. Ann’s COVID-19 CRC

Dedicated Staffing

Staff:

Opened with a dedicated team; after

conversion to CRC, monthly MDHHS stipend allowed

for a wage increase to incentivize an enhanced,

dedicated team

Daily:

Using 12-hour shifts with 1 Nurse, 1 C.N.A., 1

Medical Support Tech, 1 RN Case Manager (days)

Other Support:

Staff such as Social Work, Life

Enrichment, contracted Physicians, and Therapy

Contingency:

When staff test positive / emergency

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St. Ann’s COVID-19 CRC

Economics & Billing

Tier 3 CRC (10 – 24 beds)

Origination Stipend: $40,000

• Received within 2 weeks of application acceptance; stand alone payment

• Electronic Funds Transfer (the way Medicaid pays claims); must have a SIGMA account

• Informed there is now a Regional Incentive add-on (Region 6: Tier 3 = $60,000)

Monthly Stipend: $10,000

• Utilize this amount for dedicated CRC staff base wage increase

Per Bed Stipend: $200/occupied bed add-on to insurance per diem

• A provided document through MDHHS is given to track census (kept up-to-date daily) based off of 10-day isolation – uploaded monthly file transfer

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St. Ann’s COVID-19 CRC

MDHHS Grant Support

Fiscal Support: St. Ann’s was awarded a one-time Infection

Control Grant

• Total >$16,000

Specific fund use:

• Bipolar deionizer for the HVAC system

• Upgraded air handler filters (MERV 8 to MERV 13)

• Touchless bathroom enhancements

• Thermal scanner / health screening equipment

• Tablets for each private room with wheeled mounts

• UV cabinet for PPE

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St. Ann’s COVID-19 CRC

PPE Use and Support

PPE Use: Monitoring the burn rate that is

unique to this unit; tracked separately from

other units and levels of care at St. Ann’s

PPE Support: MDHHS provides PPE

required to support the number of CRC

staff; PPE requests are made as you run low

*Received about 2-3 weeks worth of PPE

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St. Ann’s COVID-19 CRC

Community Partnerships

Infection Prevention: Early CCU development were successful in

establishing rigorous infection control program with assistance

and partnership at Spectrum Health’s Infectious Disease Dept.

Referrals: Incorporated similar partnership model into CRC

referrals

• Set up initial meetings with Mercy Health St. Mary’s and Spectrum

Health discharge planners

• Created an internal, single point of contact

• Single cell phone and email for CRC referrals only

• Senior care organizations throughout the state (90% of our admissions

have resulted from these referrals)

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St. Ann’s COVID-19 CRC

Insurance and Payors

Intake System: Created a multi-disciplinary admission review &

intake process

• CRC Case Manager, Finance, Social Services, & Therapy

• Requiring prior authorizations from hospital discharge planners for select managed Medicare plans before admission.

• Facility-to-facility transfers: the referring facility completes the prior authorization request for ease of admission

• Some payors have not covered COVID recovery charges in our area (Grand Rapids) making our admission requirements more stringent with regards to insurance

• Pay source is not a condition of admission (we do admit Medicaid-only patients as medically appropriate for the CRC)

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St. Ann’s COVID-19 CRC

Case Management

High Turnover: LOS less than 10 days

• Admissions - reviewing for those with a discharge plan

• Discharges - some may need LTC. Communicate clearly with family to

reduce the potential to find alternate placement

Transfers for additional rehab care

• Found success at admitting/transferring after the 10-day isolation

period into our own rehab space (general population)

• Finding many of these patients need significant rehab after 10-day

isolation

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St. Ann’s COVID-19 CRC

Case Management

Bed Management: Keep 1-2 dedicated beds has internal bed

availability for potential COVID cases

• We balance this based off of infection rates in the county and outbreaks in in-house

• Keep close monitor of pending discharge dates of CRC patients –

insurance updates do pose for longer lengths of stay as appropriate and determined by the insurance case manager (e.g. NaviHealth)

• Note: we do not bill the $200/occupied bed fee to MDHHS if they

exceed the 10 isolation days

• St. Ann’s residents are tested weekly for COVID due to infection rates in Kent County

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Questions?

Care Recovery Unit (CRC):

Overview & Lessons Learned

December 2020 Executive Director Dana M. Prince, PhD

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