Elevating the Post-Acute and
Long Term Care Profession

May 27, 2021

Air Quality Grants Still Available. This is a reminder to eligible members that the Bureau of Workers Compensation (BWC) COVID-19 Indoor Air Quality Assistance Program is still open. Director of Aging Ursel McElroy urged us to encourage members who have not applied to do so. The program is available to a variety of OHCA member homes/facilities/centers, as listed on the BWC web page. Grantees can receive up to $15,000 in reimbursement for qualifying air quality expenses. The deadline for applying and for completing the project is June 30, 2021. BWC has approved more than 600 grants, but still has at least $18 million remaining to be distributed. After hearing from members, OHCA asked that the state increase the maximum grant amount to cover more of the expense and distribute the approved awards more quickly to aid providers' cash recovery. Given the deadline, however, we recommend members move forward now instead of waiting to see if our efforts succeed.

SNF Annual Survey Restart. On our latest weekly SNF member call, several members commented on their recent annual certification surveys, recently restarted by the Health Department (ODH). For these members, it had been two years or more since the last standard survey. The new surveys were similar to pre-COVID-19 annuals, with little done remotely, but took longer. The surveyors focused on more recent events instead of looking back to early in the gap period. Naturally there was somewhat more emphasis on infection control than before COVID-19, but not overwhelmingly so. It was concerning, however, that members reported surveyors saying they are citing many more deficiencies than in the past - perhaps 15-20 - albeit at low scope and severity. Some could be considered "nitpicking" deficiencies. The common thread was concern about Centers for Medicare and Medicaid Services (CMS) oversight and federal surveys. This was a small sample size, and we received another report from a member saying they received only 3 low-level deficiencies, but we thought it was worth noting. We look forward to more reports from members about their annual surveys. Remember that we meet monthly with ODH, which gives us an opportunity to discuss survey trends.

Long-Term Care COVID-19 Cases Hit New Low. This week's ODH COVID-19 dashboard for long-term care reveals 307 current cases, the fewest since the beginning of the pandemic. An increase from last week of 2 resident cases was more than offset by a drop of 21 staff cases. In conjunction with highlighting the first two winners of the Vax-a-Million sweepstakes, Governor Mike DeWine announced today that the state is eliminating the long-running Ohio Public Health Advisory System (OPHAS), the color-coded map that created confusion for long-term services and supports providers because it never coincided with the CMS positivity-based color system. The state map was based on a different, multi-factor set of measures. ODH Director Stephanie McCloud said OPHAS is no longer needed because of the increase in vaccinations and reduction of cases.

Under federal guidelines, the CMS color coding controls the frequency with which unvaccinated SNF staff must be tested for COVID-19. OHCA today formally asked the DeWine Administration to eliminate the state orders mandating twice-weekly testing for unvaccinated SNF and assisted living staff in all counties, along with the visitation orders, when they remove other health orders next Wednesday.

ODH Opens Vaccine Ordering to All Enrolled Providers. According to a new memo from ODH, they are expanding the ability to order vaccine directly through the Vaccine Ordering Management System to all enrolled COVID-19 vaccine providers. This expansion will take effect June 7, 2021, and includes all three brands of vaccine. There are minimum orders for each brand, but the minimums are 100 doses for Moderna and Johnson & Johnson (Janssen). The memo provides detailed instructions for the ordering process and lists a series of training opportunities that start tomorrow and run through next Friday. We recommend members who are enrolled as vaccine providers review the memo and consider whether they wish to pursue this opportunity to "control their destiny" relative to vaccinations.

Vaccine Reporting Requirements: CMPs to start June 14 (from AHCA/NCAL). Earlier this month, the Centers for Medicare & Medicaid Services (CMS) published an Interim Final Rule on COVID-19 Vaccine Requirements. This rule applies to residents, clients, and staff of Skilled Nursing Facilities (SNF) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs-IID). CMS also published a QSO memo to state survey agencies on how to operationalize this new requirement. [The memo does not apply to ICFs, only SNFs.]

This rule specifies that facilities must develop and implement policies and procedures to:
  • Educate all residents and staff about COVID-19 vaccines; 
  • Offer vaccination to all residents and staff; and 
  • Report to the CDC via the National Health and Safety Network (NHSN) vaccination status for residents and staff as well as use of any therapeutic treatments (e.g., monoclonal antibody). This requirement does not apply to ICFs-IID.
The rule was scheduled to go into effect on May 21, 2021. However, CMS has publicly stated that it will not enforce compliance until June 14. 

AHCA/NCAL recommends that facilities implement several important steps before June 14 to ensure compliance with this new requirement.

1. Develop a policy and procedure on offering and educating staff on the COVID-19 vaccine. AHCA/NCAL has developed a template policies and procedures for facilities to use to facilitate compliance with this new rule. In addition, AHCA/NCAL has developed a template declination form for facilities who want to use a declination form to help track staff and residents who decline the vaccine. Note that use of a declination form is not required by CMS. 

2. Track all staff and resident vaccination status. Providers must know their staff and resident vaccination status to comply with this rule. For residents, this should be documented in their medical record and include:

  • Education provided to the resident or resident representative regarding the benefits and potential risks associated with the COVID-19 vaccine (including date and name of representative); and
  • Each dose of the COVID-19 vaccine administered to the resident; or 
  • If the resident did not receive the COVID-19 vaccine due to medical contraindications or refusal.
For staff, you will need to develop a process to document that includes:
  • Staff were provided education regarding the benefits and potential risks associated with the COVID-19 vaccine (include date);
  • Staff were offered the COVID-19 vaccine or information on obtaining the COVID-19 vaccine; and
  • The COVID-19 vaccine status of staff and related information as indicated by NHSN [SNFs only].
Your database should also include which vaccine they received and the date of both shots, in case of the need for boosters later that are based on when and what vaccine a person received. To assist providers, AHCA/NCAL has developed a template staff vaccination log. Please note, under this rule, staff is defined as any individuals who work (including contractors or consultants) or volunteer in the facility once per week.
If you have not started tracking staff vaccination status, you can ask staff their vaccination status and for a copy of their vaccination card. Per the Equal Employment Opportunity Commission, you can ask the employee directly for proof of vaccination, but not their medical information. The requirement also indicates that “if a staff member is not eligible for COVID-19 vaccination because of previous immunization at another location or outside of the facility, the facility should request vaccination documentation from the staff member to confirm vaccination status.
3. Document education provided to staff and residents. Facilities should be prepared to provide samples of the materials they are using to educate staff and residents on the safety of the COVID-19 vaccine to surveyors. This must include a link to the Food and Drug Administration’s Emergency Use Agreement Fact Sheet for the vaccine(s) being offered:

4. Re-educate and offer the COVID-19 vaccine to all staff and residents who previously declined. While the QSO Memo and IFR are unclear, the intent is to make sure all staff and residents who are not vaccinated have been educated and offered the vaccine. We believe this is a good opportunity to re-educate and offer the COVID-19 vaccine to all staff and residents who previously declined. This will allow you to document your education attempts, their refusal, and show the surveyors that you are making good faith efforts to comply with this rule. 

5. Start submitting to the NHSN today. Facilities should NOT delay in submitting their vaccination data to NHSN. Facilities are required to submit data via NHSN by June 13 at midnight in order to avoid penalties. However, submitting vaccination data at the last minute will very likely lead to challenges with the submission process that will not be resolved before the deadline. Facilities should start submitting data this week to the two modules to make sure they learn how to do it correctly. Providers do NOT need to upgrade to SAMS Level-3 access to submit vaccination data. Please read this vital blog post for additional info on submitting this to NHSN. 
For more information, providers are encouraged to view the webinar recorded on this new rule or contact COVID-19@ahca.org.