Elevating the Post-Acute and
Long Term Care Profession

June 10, 2021

Don't Forget NHSN Vaccination Data Reporting. Next Monday, June 14, marks the beginning of the Centers for Medicare and Medicaid Services' (CMS's) enforcement of the vaccination reporting requirements in the recent interim final rule with comment period against SNFs. Like the COVID-19 test reporting, the vaccination reporting will be enforced through civil money penalties (CMPs). While the rule has provisions applicable to ICFs/IID, the reporting requirement does not apply. SNFs must report data by 11:59 p.m. Sunday night to avoid CMPs. We recommend that if you have not done so already, report now instead of waiting until Sunday. That way, if you have any issues getting the report submitted, you have a little time to try to resolve them before the deadline.

Even though the enforcement date has not yet arrived, CMS began publishing SNF vaccination rates on its COVID-19 data page (scroll down to "COVID-19 Vaccination"). The data are from centers that reported voluntarily as of May 30. CMS started with a table of SNFs with staff vaccination rates of 75% or more, which is linked on the page. The list includes 11 Ohio facilities. The CMS page explicitly quotes AHCA/NCAL as setting the 75% goal to be met by June 30.

OSHA Issues Emergency Temporary Standard on COVID-19 in Health Care. This morning, the Occupational Safety and Health Administration (OSHA) issued an emergency temporary standard (ETS) to protect health care workers from contracting COVID-19. OSHA issues ETSs under very limited circumstances. The agency first must determine that workers are exposed to a grave danger from new hazards, toxic substances, or agents determined to be physically harmful. This is the first ETS OSHA has issued in 38 years. OSHA drew some criticism from labor groups for limiting the ETS to health care instead of covering restaurants, meat-packing plants, etc., or simply extending the standard to all businesses.

The ETS establishes new requirements for settings where employees provide health care or health care support services including hospitals, SNFs, assisted living communities, and home health care. ICFs/IID and group homes for people with disabilities are not listed specifically, but we believe based on today's OSHA webinar on the new standard that they intend workers in these settings to be covered because they have a similar risk profile to other care environments.

The rule does exempt certain settings (like home health care) where all employees are fully vaccinated, all non-employees are screened prior to entry, and people with suspected or confirmed COVID-19 are not present. Said another way, it appears health care workers are exempt only if they work in a setting where individuals can be screened and no one with COVID-19 is permitted to enter.  

The new standard includes the following requirements for covered employers:

  • Conduct a hazard assessment and have a written plan to mitigate virus spread.
  • Designate a workplace safety coordinator(s), knowledgeable in infection control principles, with authority for implementing, monitoring, and ensuring compliance with the plan.
  • Provide certain employees with N95 respirators or other personal protective equipment.
  • Ensure 6 feet of distance between workers. In situations where this is not possible, employers should erect barriers between employees where feasible.
  • Provide workers with paid time off to get vaccinated and to recover from any side effects.
  • Require covered employees who have COVID-19 or who may be contagious to work remotely or otherwise to be separated from other workers, if possible, or give them paid time off up to $1,400 per week. For most businesses with fewer than 500 employees, tax credits in the American Rescue Plan may be reimbursed through these provisions.

The ETS exempts fully vaccinated workers from masking, distancing, and barrier requirements when in well-defined areas where there is no reasonable expectation that any person will be present with suspected or confirmed COVID-19.

The ETS summary and frequently-asked questions provide a wealth of information. We encourage all members to review the new standard quickly, as it is effective immediately upon publication in the Federal Register, which we anticipate will occur within days. Employers must comply with most provisions within 14 days and with the remaining provisions within 30 days. OSHA will use its enforcement discretion to avoid citing employers who miss a compliance deadline but are making a good faith effort to comply with the ETS. 

OSHA in Ohio agreed to conduct a webinar for OHCA on the ETS once their compliance team fully digests the new requirements. Please watch for further information as it becomes available.

ODM Managed Care Plans Move to Standardized Billing for Hospice Room and Board. Yesterday, during a stakeholder call with the Department of Medicaid (ODM) managed care policy team, OHCA learned that the Hospice Billing Workgroup made considerable progress towards standardizing hospice room and board billing to managed care plans. The managed Medicaid plans agreed to a standardized billing process under which room and board claims would be billed on a CMS-1500 claim form utilizing Healthcare Common Procedure Coding System (HCPCS) code T2046. Additionally, providers would provide the SNF's information, such as name and National Provider Identifier (NPI), in field 32 of the CMS-1500. This step would ensure that the managed care plan applies the correct per diem rate for the hospice patient. Exceptions still would exist for hospice ventilator claims and hospice Health Care Isolation Center (HCIC) claims, which hospices would continue to bill on a UB-04. For specific billing instructions for these unique situations, please contact Erin Begin.

We are awaiting detailed slides from ODM with the standardized billing requirements and effective dates for each health plan. OHCA specifically requested effective dates for United Healthcare Community Plan managed Medicaid enrollees, who have caused unique challenges for hospice agencies in the past. As we learn more about when the standardization process will be completed, we will share that information with members. OHCA asked, as its next action item, that the workgroup address health plans' inconsistent application of patient liability. 

CMS Increases Payment Rates for At-Home Vaccination. Also yesterday, CMS announced an additional payment amount for administering in-home COVID-19 vaccinations to Medicare beneficiaries who have difficulty leaving their homes, such as homebound clients, or otherwise are hard to reach. For each dose administration, CMS will pay an additional $35, bringing the total reimbursement to about $75. This amount will be adjusted slightly for the Ohio locality. For a two-dose vaccine administered in the home, reimbursement would total around $150.

So far, few Ohio home health agencies have registered as vaccine providers. If your agency has not done so because of financial constraints of low reimbursement coupled with travel costs, please take a moment to analyze whether this payment increase may result in a financially viable delivery option for your patients. Centers for Disease Control and Prevention (CDC) guidance outlines considerations, such as storage temperatures, for delivering vaccine doses to hard-to-reach settings. For more information on how to become a vaccine provider in Ohio, please see the ODH website.

Long-Term Care COVID-19 Cases Stay at 222. For the second straight week, the Health Department's COVID-19 dashboard for long-term care facilities showed 222 current cases statewide, which is the lowest level since the early days of the pandemic. There was a change in the distribution this week, as resident cases went up slightly and staff cases went down slightly, but they still made up 58% of the total.