Elevating the Post-Acute and
Long Term Care Profession

May 17, 2021

AHCA/NCAL Webinar on CMS Vaccination Rule. Last week, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule with comment period that, among other things, requires SNFs to report vaccination data to the National Healthcare Safety Network (NHSN). The rule also applies to ICFs/IID, which while not required to report data still are mandated to educate residents, families, and staff about the vaccine and to offer vaccinations. The rule takes effect May 21, 2021. CMS also published a new Quality, Safety, and Oversight (QSO) letter implementing the rule's requirements for SNFs and discussing enforcement. Tomorrow at 1:00 p.m. AHCA/NCAL's Dr. David Gifford will offer a live webinar to explain the requirements of the rule. To register, please use this link.

ODH Eliminates Aggregate POC Test Result Reporting. Last week, the Department of Health (ODH) quietly rescinded their order from March 2020 requiring laboratories to report aggregate test results. For long-term services and supports providers, this order applied to point-of-care (POC) testing, which is considered a laboratory procedure. With the order's elimination, laboratories, including those operating under a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver, no longer are required to make the daily aggregate reports. OHCA members began to inform us this morning that the website for making the reports was no longer available, then word came out on the rescission. ODH sent an email to laboratories with a copy of the order of rescission and an updated reporting policy. A key point is that while the burdensome daily aggregate reporting has been eliminated, providers conducting POC testing still must report line-level results either to NHSN or to ODH. Likewise, the requirements to report weekly to NHSN, augmented to include vaccination data, and to local health departments within 24 hours of a COVID-19 case remain in place.

Latest County Positivity Rates. As usual for a Monday, CMS published positivity rates and county colors today. The Ohio table is similar to last week's, with most counties green. There are no red counties this week, as Lawrence County, which was red before, had too few tests and was downgraded to yellow. Other changes in county color:

  • Adams County - yellow to green.
  • Brown County - yellow to green.
  • Harrison County - green to yellow.
  • Holmes County - yellow to green.
  • Mercer County - yellow to green.
  • Montgomery County - green to yellow.
  • Ottawa County - yellow to green.
  • Summit County - green to yellow.
Remember that for eye protection purposes, there is no two-week waiting period when the color changes.

HIPAA and Vaccination Status. Some members reported that since the Centers for Disease Control and Prevention (CDC) and CMS expanded the distinctions between vaccinated and unvaccinated residents, staff, and visitors in the context of relaxing various COVID-19-related restrictions, some people complained that identifying them as unvaccinated violated the Health Insurance Portability and Accountability Act (HIPAA) privacy requirements. We did not agree with this assertion, but now AHCA/NCAL has provided a helpful question-and-answer document that confirms this response. As noted in the document, it does not constitute legal advice, so if you remain concerned after reviewing it, you may wish to consult your health care legal counsel.

HRSA CAF Fund Does Not Cover mAbs. Recently, the Department of Health and Human Services announced a new Coverage Assistance Fund (CAF) through the Health Resources and Services Administration (HRSA). This fund pays for COVID-19 vaccine administration costs that are not covered by a health plan or that have an associated patient cost-share. The CAF differs from the previously-established HRSA uninsured fund, which covers all COVID-19 treatments, testing, and vaccine administration for beneficiaries with no insurance coverage. In the program materials, HRSA indicates that covered services can be found on the CMS COVID-19 vaccine administration page, which includes monoclonal antibody infusions (mAbs). Despite this listing by CMS, the HRSA CAF frequently asked questions (FAQ) document does not include billing codes for mAbs. OHCA reached out to HRSA for clarification, and they confirmed that monoclonal antibody administration is NOT covered by the HRSA CAF fund for underinsured beneficiaries. Only traditional COVID-19 vaccine administration is covered, as indicated in the code set from the FAQ. In Ohio, Medicaid does not cover any vaccine administration when billed by a SNF or home health agency, including mAbs. The HRSA CAF fund will provide relief for regular COVID-19 vaccine administration losses for underinsured patients, but it does not resolve the non-payment issue with mAbs administration for Medicaid beneficiaries when billed by a home health agency or SNF provider. 

State Masking/Distancing Order Updated Temporarily. ODH today amended their order for the general public on facial coverings, social distancing, and non-congregating to correspond to last week's CDC guidance on this same topic. Like the CDC guidance, the state order draws sharp distinctions on all three points between people who have been fully vaccinated and those who have not. Also like CDC, the state specified that the relaxed order "does not apply to jails, prison facilities, nursing homes, assisted living facilities, or adult day services centers for elderly adults." It also does not apply to schools. In keeping with Governor Mike DeWine's announcement that all health orders applying to the general public will be lifted June 2, today's revised order will be in effect for only about two weeks.

Emergency Legislation Extends Temporary Nursing Licenses. Last Friday, Governor DeWine signed House Bill (HB) 6, which expands which health professionals may administer COVID-19 vaccinations. HB 6 is an emergency measure that took effect immediately. In addition to its main provisions, the bill also contains Section 6 that extends the expiration date of temporary nursing licenses from March 2, 2021, to July 1, 2021. This extension, however, is subject to several conditions, including that the temporary licensee has not failed the licensure examination and that they take it within 60 days after receiving authorization to test.