COVID-19

COVID-19 and the Disability Manager: Part 2

kkrewer — Thu, 14 May 2020 20:42:15 +0000

COVID-19 and the Disability Manager: Part 2 kkrewer Thu, 05/14/2020 - 16:42

FAMILIES FIRST CORONAVIRUS RESPONSE ACT (FFCRA) PART 2

The rapid developments around COVID-19 from both the regulatory and Human Resources perspectives require Certified Disability Management Specialists® (CDMS®) to react quickly with the information needed. In the first part of this blog, we identified the basic components of the Families First Coronavirus Relief Act (FFCRA) as they relate to affected employees (Mitchell, 2020). Here, in part two, we will look at the basic requirements for employees and employers in applying for these new, temporary benefits.

Amendments to the Family Medical Leave Act (FMLA), (Department of Labor, n.d.), specifically the Families First Coronavirus Relief Act (FFCRA), (Department of Labor, 2020) and its related paid time off rules require very specific information to be put in place for affected employees. This requires the use of a written request form (Kutakrock,2020).

Written Request Forms

An employee’s eligibility for paid sick or paid family leave should be based on a written request from the employee that includes the following:

The employee’s name;
The date(s) for which leave is requested;
The COVID-19 related reason the employee is requesting leave and written support for such reason; and
A statement that the employee is unable to work, including by means of telework, as relates to the issue identified in number 3.
If the leave is due to a quarantine or self-quarantine, then the request should include the name of the government entity ordering quarantine, or the healthcare provider advising self-quarantine, and
If the person ordered/recommended for quarantine is not the employee, then that person’s name needs to be provided.

Employers should maintain this information to substantiate employee eligibility for the sick leave or family leave credits.

Childcare

The FFCRA makes accommodation for leave so an employee, with no other resources, can apply for a leave to take care of minor children. It is important for the CDMS to understand these provisions, to be the resource to the employee and the employer.

Requests for childcare leave require documentation as follows:
- the employee’s written request should include the name and age of the child (or children) to be cared for;
- the name of the school that has closed or place of care that is unavailable;
- and a representation that no other person will be providing care for the child during the period for which the employee is receiving family medical leave.

If the employee needs to provide care for a child older than 14 during daylight hours, which renders them unable to work (even remotely), then the request should include a description of what circumstances exist that the employee needs to provide care.

There is a high level of detail required for the application of these regulatory changes. The Certified Disability Management Specialist is in the unique position to wade through the weeds and provide much-needed clarity to both HR, organizational leadership, and the affected employees.

We, at the Commission, hope that it is helpful to you in your work. We appreciate all the efforts you have put into responding to this ongoing health crisis and are here to help interpret the rapidly changing regulatory arena.

References

Certified Disability Management Specialists (CDMS), (n.d.). Introduction to Disability Management. Core Knowledge Curriculum, Domain I, 2nd ED. Topic 4. Accessed April 6, 2020 from: https://cdmscourses.globalclassroom.us/stratus/mod/page/view.php?id=632

Kutakrock.com (2020). Employers Encouraged to Use Specific FFCRA Leave Request Forms. Accessed April 24, 202 from: https://www.kutakrock.com/newspublications/publications/2020/04/covid19-resources_ffcra-leave-request-forms

Mitchell, Ellen (2020). COVID-19 and the Disability Manager: Families First Coronavirus Response Act (FFCRA) Part One. Accessed May 1, 2020 from: https://ccmcertification.org/blog/covid-19-and-disability-manager

United States Department of Labor (2020). FFCRA Questions and Answers. Accessed April 17, 2020 from: https://www.dol.gov/agencies/whd/pandemic/ffcra-questions

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Disability Manager

Coronavirus

Understanding the enemy: A curated list of COVID-19 resources for case managers

kkrewer — Thu, 30 Apr 2020 17:44:52 +0000

Understanding the enemy: A curated list of COVID-19 resources for case managers kkrewer Thu, 04/30/2020 - 13:44

Case managers are struggling. Preliminary results from over 5,900 CCMs in our recent “Checking in With Our CCMs” survey reveal some of the burdens our case managers carry, and it’s eye-opening.

We’re not that surprised by the results on the professional side. Most case managers are working remotely (57%) and have limited contact with clients and patients (55%). Some, however, have been called upon to work on the frontlines. Regardless, many (40%) are fielding more questions than ever from clients and patients. Significant percentages are dealing with staff shortages (15%) and lack of supplies (28%). Clearly, work has become more challenging, but that’s to be expected. And we know that professional case managers will always rise to the challenge.

What has been a surprise is how much the coronavirus has personally affected case managers. We’re seeing that, as you continue to advocate for clients and connect them to the resources they need, many case managers themselves carry a heavy burden. We’re seeing significant percentages for food scarcity among case managers (16.6%) and income loss (30.5%). More than 21% of today’s case managers report clinical health issues. About 5% of those responding say the practice or organization they work for has shut down completely.

Most distressing of all, many more than we anticipated—5.3% of case managers—report losing loved ones to COVID-19.

It’s a dark time for many in our profession and yet, as we move forward with resilience and commitment, we find sources of encouragement. I found one in the preliminary results: There’s a real hunger to learn about the coronavirus. Our CCMs want to know more so they can be trusted resources to clients and to colleagues—and perhaps to friends and family.

Mental health

We know the COVID-19 pandemic and resulting economic downturn are taking a toll on your mental health. In fact, it’s negatively affected the mental health of 45% of U.S. adults, according to a recent Kaiser Family Foundation poll.

So the first resource we’ll offer is a simple three-pager from WHO with a self-explanatory title: “Mental health and psychosocial considerations during the COVID-19 outbreak.”

Webinars and training

Organizations and companies in the health and medical space are making available an array of COVID-19-related webinars and other educational programs we would like to share with you—most are free.

The National Association of Social Workers’ (NASW) COVID-19 page includes educational and advocacy resources, broken down by category (e.g., ethics, workforce, etc.). It also has links to webinars that are free to NASW members.

The Social Work Hospice & Palliative Care Network’s dedicated COVID-19 page features webinars and communication tools. It also provides information about a nightly (M-TH) online discussion for hospice and palliative care professionals.

The Alliance for Health Policy has produced a series of COVID-19 webinars. The focus is on public health, but some have direct application for case managers, including COVID-19 Webinar Series Session 9 - Social Isolation and Loneliness.

The Institute for Health Improvement has curated a collection of COVID-19 guidance and resources, including a link to its Virtual Learning Hour Special Series.

The National Academy of Medicine provides an array of coronavirus resources, including webinars and videos.

American Academy of Ambulatory Care Nursing’s site features links to basic resources as well as several webinars. Of particular interest is the section “Telephone Triage and COVID-19.”

American Association of Colleges of Nursing’s robust COVID-19 Response Webinar Series deserves a mention. Many of the topics understandably relate to academia, but some have applications for case managers across professional settings.

Research

Publishers and professional societies are stepping up; most are making COVID-19 research available at no charge. Among the many journals providing free access to COVID-19-related research are:

Lippincott Nursing Center: COVID-19’s comprehensive, frequently updated website offers links to journal articles, reports and educational materials. It also features podcasts and blog posts and provides a link to each state’s board of nursing.

UpToDate: Coronavirus disease: This evidence-based, peer-reviewed and frequently updated clinical decision-support resource provides the most current information on COVID-19. It covers everything from epidemiology and virology to prevention and management. Clickable footnotes show you abstracts of all the original research cited. It’s a good place to start.

News sources

Chances are, you, your clients and colleagues are overwhelmed with news about COVID-19, so we’ll keep this list short.

MedPage Today and Medscape, targeted primarily to health care professionals, provide Coronavirus coverage with a focus on research. MedPage also features links to educational resources that are pre-approved for CCM continuing education credits.

Kaiser Health News, targeted to a broad audience, provides a daily roundup of news from both mainstream media and health-related publications—including original reporting.

Client-facing resources

Many of your clients—or their loved ones—may be confused and overwhelmed by all the information coming at them.

COVID-19 basics (UpToDate): Like the professional version, this is a peer-reviewed and regularly updated overview of the COVID basics—except this one is designed for consumers.

CDC’s public-facing COVID-19 site: Again, this covers the basics; it includes links to updates and surveillance data, but it’s mostly about the basics of staying healthy and recognizing symptoms.

In addition, Kaiser Health News, mentioned above, provides a daily non-partisan, curated roundup of Coronavirus-related news.

The Big Three

We’d be remiss if we didn’t include links to what are probably the three most important sites for COVID-19 information. You’re familiar with them, of course: CDC, WHO, and the National Institutes of Health.

Up next

We’ll be in touch soon with the full results of the Commission’s “Checking in With Our CCMs” survey. And if you’ve found resources to help you better fight this pandemic, let us know through the Commission’s social media channels so we can share them with your colleagues.

Until then, be well.

Note: Please visit our COVID-19 webpage for updates on the Commission and to stay current on how to get certified and stay certified. You may also find our brief COVID-19 podcasts here.

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Case Manager

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Coronavirus

COVID-19 and the Disability Manager

kkrewer — Wed, 29 Apr 2020 21:04:34 +0000

COVID-19 and the Disability Manager kkrewer Wed, 04/29/2020 - 17:04

FAMILIES FIRST CORONAVIRUS RESPONSE ACT (FFCRA) PART 1

The rapid developments around COVID-19 from both the regulatory and Human Resources perspectives require Disability Management Specialists (DMS) to react quickly with the information needed. The delivery of disability management services involves a complex interplay among workers with disabilities, employers, insurance carriers, labor unions, medical service providers, government agencies, and others (CDMS, n.d.).

We will look at recent temporary revisions made to the Family Medical Leave Act (FMLA) and how they impact the work of the DMS.

Now, the question arises…Where is the workplace???

We are all aware by now, that many employers in areas hard-hit by COVID 19 have transitioned their staff to a remote setting, usually from home. We also know that as of this writing there are differing definitions of what constitutes essential personnel based on geographic location.

That essential personnel might be found in grocery or warehouse chains, big box stores, health care, municipal services, and other sites, as determined by state and other regulatory bodies. More on that in a moment!

Regardless of how the workplace is identified in these times, regulations remain in play and it is important to have a basic understanding of the rules governing process and stakeholder rights and obligations (CDMS, n.d.).

Legal and regulatory guidelines can be very complicated in “normal” times. Regarding disability management and COVID-19, one needs to be familiar with and stay current on changes to the FMLA (CDMS, n.d.), (Dept. of Labor, n.d.).

The newly passed Families First Coronavirus Response Act (FFCRA) went into effect on April 1, 2020. It will sunset on December 31, 2020. It adds new requirements for paid sick leave and family medical leave act (FMLA) enhancements for businesses with fewer than 500 employees. Employers with less than 50 employees can seek hardship exemptions for some of the requirements.

Here are the key differences from the FMLA in its original state (Dept. of Labor, n.d.). An employee is eligible if they:

Are subject to Federal, State or Local quarantine or isolation order related to COVID-19;
Have been advised by a health care provider to self-quarantine;
Are symptomatic for and awaiting a diagnosis of COVID-19;
Are caring for someone described in 1 or 2 (Dept. of Labor, 2020)

Employers must provide 2 weeks PAID sick leave at the usual pay rate of employees who are:

Sick with COVID-19
On Quarantine for COVID-19

Employees do NOT have to use PTO/earned sick time to be eligible. Employees can receive two weeks of leave at 2/3 pay to care for a family member sick with COVID-19.

Additionally, employers must provide up to 10 additional weeks of paid leave related to an employee or employee’s family coping with COVID-19. This is paid at 2/3 the employee’s salary up to $200/day. This includes loss of childcare due to COVID-19 closures.

These benefits are cumulative and are capped at 80 hours. Therefore, if an employee has already used two weeks of leave for being sick or on quarantine from COVID-19, they cannot then apply for additional payment for another reason. An employee can always use their own PTO or paid sick leave to cover in addition to FFCRA (Childress, 2020).

There are exceptions to every rule…

Remember when I said, “more on that in a moment?” Here’s the moment…

Although the existing FMLA (Dept. of Labor, n.d.) stands as always, not every industry or employer is covered by the temporary amendments (Dept. of Labor, 2020).

Most employees of the federal government are covered by Title II of the FMLA and are not covered by the expanded family and medical leave provisions of the FFCRA. However, federal employees covered by Title II of the FMLA are covered by the paid sick leave provision. (Dept. of Labor, 2020).
Health care employers are exempted from these amendments, including:
1. Doctor’s offices, hospitals, health care centers, clinics, post-secondary educational institutions offering health care instruction, medical schools, local health department or agencies, nursing facilities/homes, retirement facilities, home health care providers, labs, pharmacies;
Emergency transport:
1. This includes military or national guard, law enforcement officers, correctional institution personnel, fire fighters, emergency medical services personnel, physicians, nurses, public health personnel, emergency medical technicians, paramedics, emergency management personnel, 911 operators, public works personnel.

Depending on your role in your organization, you may be called upon to interpret or consult on policy development to help your affected workforce. As this pandemic continues, there could be much more to follow. You will need to develop a process with these and other resources, so you are aware of how various regulatory and legal aspects can impact your decision making.

We, at the CCMC, hope that it is helpful to you in your work. We appreciate all the efforts you have put into responding to this ongoing health crisis and are here to help interpret the rapidly changing regulatory arena. More to come on this topic!

References

Childress, R. (2020). How the new COVID-19 sick leave FMLA law could impact associations. Accessed April 10, 2020 from: https://associationsnow.com/2020/04/how-the-new-covid-19-sick-leave-fmla-law-could-impact-associations/?utm_medium=email&utm_source=rasa_io

United States Department of Labor (n.d.). Family Medical Leave Act. Accessed April 10, 2020 from: www.dol.gov/elaws/fmla.htm

United States Department of Labor (2020). FFCRA Questions and Answers. Accessed April 17, 2020 from: https://www.dol.gov/agencies/whd/pandemic/ffcra-questions

Tags

COVID-19

Disability Manager

Coronavirus

There is no Magic Wand!

kkrewer — Wed, 22 Apr 2020 15:31:20 +0000

There is no Magic Wand! kkrewer Wed, 04/22/2020 - 11:31

FIVE WEEKS LATER…

It has been five weeks since the White House announced a series of regulatory waivers designed to help providers and states in responding to the spread of COVID-19 under Section 1135 of the Social Security Act.

Section 1135 waivers are intended to ensure that enough healthcare items and services are available to meet the needs of individuals enrolled in Medicare, Medicaid, CHIP, and other healthcare programs and that providers who provide such services in good faith can be reimbursed and exempted from sanctions unless there is evidence of fraud or abuse. (ASTHO, 2020)

Since that time, health care systems have used this flexibility to respond to the evolving health care crises caused by COVID-19.

Make them disappear!

Like the magicians of old, we are being asked to make patients “disappear” from acute care more quickly. The 1135 waiver helps, as CMS waived the three-day hospitalization rule to cover a skilled nursing facility (SNF) under Medicare. Theoretically, this would enable us to send discharge ready patients to SNFs more quickly and admit acutely ill COVID-19 patients.

However, there is no magic here, and recent news reports of high numbers of infected persons in SNFs around the country are likely an impediment to this quick turnaround.

SNFs are facing their own challenges in protecting their patients and staff from COVID-19 and require support providers to take on this additional responsibility (Buys, 2020).

SNFs are concerned at the idea of taking on patients who may have COVID-19 infections. (Graham, 2020). After all, we have all heard of the facility in Kirkland, Washington that experienced the first “hot spot” in a long-term care setting, which resulted in at least 37 deaths. As of April 18, 2020, there were 7300 COVID-19 deaths in SNFs reported nationwide. (ABCNEWS, 2020).

The American Health Care Association (AHCA), an industry organization recommended on March 30th, that SNFs could accept known negative, or asymptomatic patients, and went further to state if someone has symptoms such as a dry cough or fever, they “should be tested for COVID-19 before being admitted to the facility.” If someone is COVID-19 positive, they should be kept only “with other COVID positive residents.” However, these recommendations are being met with pushback in certain areas (Graham, 2020).

Where are patients to go?

The answers to these questions vary from state to state. In NY, for example, beds were made available at the Javits Convention Center to manage the care of COVID-19 patients, discharged from acute care, but in need of continuing care. Other municipalities have expanded care into hotels, gymnasiums, and other large sites, to decompress the acute care hospitals. (Graham, 2020). In the absence of such alternatives, the question remains, “where do the patients go?”

So, what is a Case Manager to do?

If there were a magic wand, it would be easy, but case managers, even in the most difficult of times, are charged with providing safe transitions of care, and the Case Management standards of practice (CMSA, 2016) include advocacy for the patient and financial stewardship (Miondonski, 2012). Chapter VIII, Section N of The Standards of Practice for Case Management (CMSA, 2016) state: “The professional case manager should integrate factors related to quality, safety, access, and cost-effectiveness in assessing, planning, implementing, and evaluating health resources for client care.”

Carolyn Buys (2020), writer for the Advisory Board, interviewed leadership at the UW Medicine in Seattle, WA to get insight as to how best to accomplish discharge planning in these trying times.

Among the recommendations were the following:

HOME first. On considering discharge plans, the home should be number one. This might be a better option for our frail patients than SNF, and, as most families are home due to “stay-at-home” rules, easier to facilitate. If the discharged patient is positive for Coronavirus, then this prevents spread within an SNF. If they are not, it helps prevent their acquiring it.
Set expectations of post-acute providers. Clear communication with providers is the key to success. Emphasize what you and your organization CAN do to facilitate a safe transition, rather than what you can’t.
Engage in regular conversation with your post-acute partners. Ask:
- What are the current admission requirements/restrictions?
  - What can be done to address them?
- What information, above and beyond the usual, do they need about the potential patient?
- What support can you provide for them to expedite a transition?
- What is the bed capacity for COVID-19 positive/negative patients?
  - How many beds are available? (Ask this every day!)

So, you see, there may not be a magic wand. But there are certainly things we as case managers can do to provide the safest possible discharge plans for our patients in this unprecedented health care crisis.

References

ABC News, (2020). At least 7,300 deaths confirmed at nursing homes around the nation. Accessed April 20, 2020 from: https://abcnews.go.com/WNT/video/7300-deaths-confirmed-nursing-homes-nation-70227436

ASTHO, (2020). Emergency Authority and Immunity Toolkit. Robert T. Stafford disaster relief and emergency assistance fact sheet. Accessed April 14, 2020 from: https://www.astho.org/Programs/Preparedness/Public-Health-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Robert-T--Stafford-Disaster-Relief-and-Emergency-Assistance-Act-Fact-Sheet/

Buys, C. (2020). 7 lessons on discharge planning during COVID-19 from UW Medicine. Accessed April, 20, 2020 from: https://www.advisory.com/daily-briefing/2020/04/03/uw-medicine

Graham, J. (2020). Coronavirus patients caught in conflict between hospital and nursing homes. Accessed April 20, 2020 from: https://khn.org/news/coronavirus-patients-caught-in-conflict-between-hospital-and-nursing-homes/

McGuire/Woods.com. (2020). CMS responds to COVID-19 emergency declaration. Accesed April 13, 2020 from: https://www.mcguirewoods.com/client-resources/Alerts/2020/3/cms-responds-to-covid-19-national-emergency-declaration

Miodonski, K. (2012). Aligning Case Management Processes with the Revenue Cycle. Becker’s Hospital CFO Report. 6/8/2012. Accessed from https://beckershospitalreview.com/finance/aligning-case-management-processes-with-the-revenue-cycle.html

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