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November 10, 2020


COVID-19 Cases Explode Again. New COVID-19 cases in Ohio today exceeded 6,500, almost 1,000 more than the previous daily record set just last Friday. Governor Mike DeWine announced plans for a statewide address on the escalating crisis tomorrow evening. The number of new COVID-19 patients hospitalized, 386, also blew through last Friday's previous record of 231. Total hospitalizations reached a new high of 2,747.

26 CMS Red Counties. This week's Centers for Medicare and Medicaid Services (CMS) county-level COVID-19 test positivity ratings came out a day later than usual and contained more dire news for Ohio. Twenty-six counties are now shown as red, an increase of 10 from last week. Only four remain green this week, with the rest yellow. The consequences are sad, with thousands more SNF staff members and residents subjected to twice-a-week testing and denied indoor visitation.

CMS Announces Coverage of Monoclonal Antibody Treatment. At the same time as work proceeds rapidly on developing COVID-19 vaccines, scientists also are researching therapeutics, including monoclonal antibodies, to treat the disease. The following is a CMS press release this evening that follows yesterday's decision by the Food and Drug Administration to give emergency use authorization to the Eli Lilly monoclonal antibody infusion. This therapeutic was tested on SNF and assisted living residents, among others, and is authorized for patients older than 12, including those who are elderly or have chronic health conditions.

The Centers for Medicare & Medicaid Services announced that starting today, Medicare beneficiaries can receive coverage of monoclonal antibodies to treat coronavirus disease 2019 (COVID-19) with no cost-sharing during the public health emergency (PHE). CMS’ coverage of monoclonal antibody infusions applies to bamlanivimab, which received an emergency use authorization (EUA) from the U.S. Food and Drug Administration yesterday.

“Today, CMS is announcing a historic, first-of-its kind policy that drastically expands access to COVID-19 monoclonal antibodies to beneficiaries without cost sharing,” said CMS Administrator Seema Verma. “Our timely approach means beneficiaries can receive these potentially life-saving therapies in a range of settings – such as in a doctor’s office, nursing home, infusion centers, as long as safety precautions can be met. This aggressive action and innovative approach will undoubtedly save lives.”

CMS anticipates that this monoclonal antibody product will initially be given to health care providers at no charge. Medicare will not pay for the monoclonal antibody products that providers receive free but today’s action provides for reimbursement for the infusion of the product.  When health care providers begin to purchase monoclonal antibody products, Medicare anticipates setting the payment rate in the same way it set the payment rates for COVID-19 vaccines, such as based on 95% of the average wholesale price for COVID-19 vaccines in many provider settings. CMS will issue billing and coding instructions for health care providers in the coming days.

CMS anticipates the announcement today will allow for a broad range of providers and suppliers, including freestanding and hospital-based infusion centers, home health agencies, nursing homes, and entities with whom nursing homes contract, to administer this treatment in accordance with the EUA, and bill Medicare to administer these infusions.

Under section 6008 of the Families First Coronavirus Response Act (FFCRA), state and territorial Medicaid programs may receive a temporary 6.2 percentage point increase in the Federal Medical Assistance Percentage (FMAP), through the end of the quarter in which the COVID-19 PHE ends. A condition for receipt of this enhanced federal match is that a state or territory must cover COVID-19 testing services and treatments, including vaccines and their administration, specialized equipment, and therapies for Medicaid enrollees without cost sharing. This means that this monoclonal antibody infusion is expected to be covered when furnished to Medicaid beneficiaries, in accordance with the EUA, during this period, with limited exceptions. 

To view the Monoclonal Antibody COVID-19 Infusion Program Instruction, visit: https://www.cms.gov/files/document/covid-medicare-monoclonal-antibody-infusion-program-instruction.pdf

OHCA Photo Contest - Deadline November 15! Now is the time to enter our photo contest with your best depictions of moments in the lives of long-term services and supports staff and the people they serve. Despite the ravages of COVID-19, there is still tenderness and joy in this noble work. Contest winners receive cash prizes of $500, $300, and $200. To download the submission and photo release forms, click here. Email them to msmith@ohca.org along with your photo entry to be automatically entered to win. Photos will be posted on the OHCA Facebook page, and voting will occur via likes/comments, so don't forget to share!

ODH Frequently-Asked Questions. Often in the past, we shared in the COVID-19 Update verbal interpretations of rules and guidelines from the Department of Health's (ODH's) survey and enforcement staff and from the Bureau of Infectious Disease. This week, ODH moved to a written format whereby the provider associations submit questions and ODH provides answers. While we miss the opportunity to discuss and debate the issues, we long asked for more written guidance from ODH. The first installment of the question-and-answer document addresses several questions the associations posed last week and includes references to Centers for Disease Control and Prevention and CMS guidelines.