Elevating the Post-Acute and
Long Term Care Profession

June 8, 2021

Senate Finance Passes Budget. This afternoon, the Senate Finance Committee reported out House Bill (HB) 110, the state budget bill, after earlier adopting an omnibus amendment. The bill will go to the Senate floor tomorrow, setting up a conference committee process that will start next week. While the omnibus amendment has not yet been incorporated into the text of the bill, we can report that there are several changes relevant to long-term services and supports. Generally they do not change funding levels in last week's Senate substitute bill, but make language revisions. The most significant items are:

  • An amendment to the SNF reimbursement provisions clarifying that the Department of Medicaid must rebase rates by the effective date of the bill (approximately October 1, 2021) and pay the rebased rates retroactively, removing the occupancy penalty for the quality incentive, maintaining the penalty on changes of operator in a less stringent form, and excluding Special Focus Facilities from the quality incentive.
  • A change to the ICF/IID reimbursement language that gives each ICF a 2% rate increase for State Fiscal Year (SFY) 2022 but returns to the "cap and rollback" methodology for SFY 2023, with an additional 2% increase to the cap as provided in the substitute bill.
  • A provision expanding the PASSPORT waiver rate increase already in the bill to cover day services for older adults. The waiver and home health funding was otherwise unchanged from the substitute bill.
  • Language that appears to prohibit the Department of Developmental Disabilities from allocating exit waivers for two years, along with a separate provision requiring a joint legislative committee to review Disability Rights Ohio every two years.
  • Agreed-upon changes to home care licensing provisions in the House-passed budget that the Senate substitute had stripped out. Those provisions came from House Bill 179.
The final Senate budget is a significant improvement for OHCA members compared to the House version, so we will work to retain the Senate language in conference committee.

ICF Regulatory Updates. Today, OHCA met with both the Department of Health (ODH) and the Centers for Medicare and Medicaid Services (CMS) to discuss ICF regulations and surveys. OHCA submitted several questions to both ODH and CMS related to infection control expectations, the interim final rule with comment period (IFC) regarding vaccinations, and the revised visitation guidance. 

ODH’s Rick Hoover shared that surveyors apply CMS Quality, Safety, and Oversight memos (QSOs). He specifically mentioned QSO-21-14-ICF/IID & PRTF, which was revised just last week. While we discussed the difference between “should/may” and “must” language in the QSO relative to which provisions are recommendations/best practices instead of being citable as regulatory requirements, ODH generally believes ICFs should follow CMS's recommendations.

Specifically, Mr. Hoover said ICFs should require staff to continue wearing masks, to be screened, and to have their temperatures taken daily, regardless of vaccination status and in compliance with current CDC guidance. ICFs also should screen residents for symptoms and check their temperatures daily. ODH recommends residents wear masks in the community and believes ICFs should require masks for staff per ICF policy. Mr. Hoover recognized that some ICFs do not operate their own day programs and would not have policies to cover staff of day programs, but should address source control (masking) for residents attending day programs in their infection control policies. 

During the CMS call, the agency’s Don Howard also pointed to the revised QSO-21-14 guidance. OHCA once again asked for clarification on what is recommendation vs. what is regulatory and can be cited on survey. While Mr. Howard agreed with the general statement that items listed with the “should/may” language are recommendations and those with “must” are regulations, CMS’s Dianna Wardlow-Dotter (from the Safety and Oversight Group) said providers can refer back to QSO-20-20-ALL and its infection control survey tool to get a better understanding of what surveyors will expect during the survey process.

Ms. Wardlow-Dotter also said the national associations can send specific questions/examples to Mr. Howard for responses from the Safety and Oversight Group. Representatives from the Centers for Disease Control and Prevention (CDC) also participated in the call and shared 5 questions CDC and CMS would like to ask stakeholders regarding vaccination data. Finally, Mr. Howard confirmed that CMS is working on guidance for ICFs under the IFC for vaccinations. That meant he was unable to answer questions about the IFC, but he did take feedback from attendees, including concerns about increased administrative burdens during a workforce crisis and the potential for losing job candidates if CMS requires ICFs to track their vaccination status. 

Follow-Up on Johnson & Johnson Vaccine. Yesterday we reported that the state issued an urgent appeal via Governor's press release to vaccine providers to use 200,000 doses of Johnson & Johnson vaccine that expire in about two weeks. ODH provided another communication that gives further suggestions to vaccine providers for these doses, including working with local developmental disabilities boards and long-term care facilities to identify people who need to be vaccinated. This might be an opportunity for members who need vaccinations but are not vaccine providers.

Notification and Reporting Requirements for SNFs. We continue to receive many questions about reporting, particularly with the advent of the IFC requiring SNFs (not ICFs) to report vaccination data to the National Healthcare Safety Network (NHSN). In addition, members report that some local health departments ask them to report weekly on COVID-19 cases whether they have them or not. These requests in some cases may be tied to outbreaks, but in any event, weekly reporting to local health departments is not required. What is required:

  • To local health department immediately: any suspected or confirmed cases.
  • Residents/families by 5 p.m. next calendar day after either a single confirmed case or 3 or more residents or staff with new onset of respiratory symptoms occurring within 72 hours of each other.
  • Cumulative updates for residents/families at least weekly.
  • ODH order: copy of notification materials to ODH (one time).
  • To NHSN:

Survey-Related Materials. On today's SNF member call, members requested links to materials used for annual surveys. Here are the two documents: