Elevating the Post-Acute and
Long Term Care Profession

May 5, 2021

Supplemental Medicaid Payments for Certain Waiver Providers. The Department of Medicaid (ODM) informed OHCA that they intend to make supplemental pandemic relief payments to providers of specific services under the ODM and Department of Aging waivers. The payments, similar to those the Department of Developmental Disabilities made to ID/DD waiver providers last month, are authorized by a state Appendix K submission the Centers for Medicare and Medicaid Services (CMS) approved in March. Eligible waiver services are nursing, personal care, and home care attendant under the PASSPORT, Ohio Home Care, and MyCare Ohio Waivers. Assisted living is not included, nor are Medicaid state plan services such as home health, private duty nursing, or hospice. Both agency and non-agency providers of the specified services are eligible. ODM identified 3,475 providers who will receive lump-sum payments totaling $28 million. The payment amounts, which will average around $8,000, will be 16% of each provider's Medicaid receipts during August, September, and October 2020. The payments will be made either May 17 or 24. No action is needed by a provider to receive the payment.

Questions and Answers. The following are answers to questions that remained from the SNF member call on Tuesday. Some of them were answered on the call, but we aren't sure which, so we erred on the side of including them. The answers pertain to SNFs, although the information also may be of interest to other providers.

  • ODH seems to be addressing testing, but will they adopt the other portions of CMS guidance around residents and masking, dining, activities?

We view the other items as self-effectuating because ODH does not have orders on them that conflict with the federal guidance.

  • Any relief coming on reporting requirements? 

None yet. Most of the reporting is federally mandated and has not changed.

  • Will the infection prevention surveys slow or cease based on facility cases being so low?
Focused Infection Control surveys already have been significantly reduced. The reduction in cases undoubtedly plays a part in that, along with resumption of annuals.
  • As always … update on temporary nurse aides?
There is no change on that. CMS has not identified an end date for the waiver, but will allow significant flexibility when it does end.
  • Can a well fitting mask be considered to be a surgical mask only? Or does it still need to be covered with a cloth mask as well, speaking of a green county of course?
Covering with a cloth mask is one option to make it well-fitting. Here is the text from the Centers for Disease Control and Prevention (CDC) guidance: "A well-fitting facemask (e.g., selection of a facemask with a nose wire to help the facemask conform to the face; selection of a facemask with ties rather than ear loops; use of a mask fitter; tying the facemask’s ear loops and tucking in the side pleats; fastening the facemask’s ear loops behind the wear’s head; use of a cloth mask over the facemask to help it conform to the wearer’s face)."
  • Is there any updated guidance on contractor testing? Are we still required to keep a copy of a vendor's recent test?
CMS QSO-20-38 lumps contractors in with facility employees for the testing requirements, the exemption for fully vaccinated staff applies to contractors (e.g., hospice personnel) as well. If the contractor still requires testing (i.e., is unvaccinated), you still should maintain documentation that they met the required frequency. If the contractor is vaccinated, you should maintain documentation of that.
  • Can we ask the state about getting rid of masks for anyone fully vaccinated? This would be more of an incentive for unvaccinated staff than to be not tested 2 times a week.
Universal source control is a federal mandate that the state could not remove. CDC did eliminate the mask requirement for fully vaccinated staff in gatherings with (only) other vaccinated staff.
  • Can staff wear surgical masks in green color code? Do we still always need eye protection no matter the color?
Yes, staff can wear well-fitting surgical masks in CMS green counties except in situations that require full personal protective equipment (PPE). Staff also can wear well-fitting surgical masks in red and yellow counties, as one of the three available options. Aside from full-PPE situations, eye protection is needed only in CMS red and yellow counties.
  • Do the surgical mask need to be ones that go around the head and not over the ears?

No, they need to be well-fitting. Ties are one method of making a surgical mask well-fitting (see question above for more examples).

  • So we can take our eye protection off now? Or we have to be green for 2 weeks before we can remove them?
No, the 2-week waiting period only applies to testing under the CMS guidelines (colors do not matter in the new state order), not to eye protection.
  • So when are N95s mandated? Based on colors or just outbreak/transmission based precautions and quarantine?
Just in situations when full PPE is required, not based on colors. N95s are one of three options when a county is red or yellow.
  • Are surveyors asking for vaccine cards to determine which staff are vaccinated?
We have not heard anything from members about what surveyors are requesting, but we would recommend maintaining documentation of vaccination status for both residents and staff. In many cases, this would be the records you keep of who was vaccinated during the clinics.
  • If an employee is vaccinated, do they still have to wear N95s in rooms for residents in isolation?

Yes, they would still need to wear full PPE, including N95s. CDC was very clear that there is no change in the PPE recommendations, only for source control in gatherings of fully vaccinated staff.