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November 17, 2020

Governor Announces 10:00 p.m. Curfew. At his press conference today, Governor Mike DeWine said a forthcoming order, effective Thursday, will establish a 21-day curfew between 10:00 p.m. and 5:00 a.m. The language of the order is not available yet, but the press release from the Governor's Office suggested it is not really a curfew in the common understanding of that term:

The curfew will not apply to those going to or from work, those who have an emergency, or those who need medical care. The curfew is not intended to stop anyone from getting groceries or going to a pharmacy. Picking up carry-out or a drive-thru meal and ordering for delivery will be permitted, but serving food and drink in person must cease at 10 p.m. 

New SNF Testing Schedule for Next Four Weeks. This morning, the state published via the Enhanced Information Dissemination and Collection System (EIDC) the SNF testing schedule for the four weeks starting next Monday. Here is the EIDC notice announcing the schedule, with additional explanation:

The next four-week test schedule for November 23, 2020 through December 18, 2020 is attached. Moving forward, please pick up the facility’s test schedule via the Long-Term Care Facility Testing Schedule utility located on our website.

Note that there is no PCR specimen collection planned for Wednesday, November 25, 2020 and Thursday, November 26, 2020. Please ensure you test in alignment with this schedule.

Lastly, the test schedule is reflective of the state-supported selection your facility chose via the opt-in/opt-out survey. The facility will receive the following supplies based on the option selected:

Option One: Alternating PCR & Antigen

  1. 2-rounds PCR for staff;
  2. 2-rounds rapid antigen for staff;
  3. Rapid antigen reserve to be utilized for staff and/or residents testing due to positivity or outbreak testing needs

Option Two: Antigen Test Only

  1. 2-rounds rapid antigen for staff;
  2. Rapid antigen reserve to be utilized for staff and/or resident testing due to positivity or outbreak testing needs

Option Three: PCR Test Only

  1. 2-rounds PCR for staff

Continue to visit our website as resources surrounding the state-supported testing program are added. Feel free to email any questions to

This afternoon, we heard from a number of members concerned about laboratory changes, in particular switches from Quest Diagnostics to other laboratories. This creates additional administrative burden to enter information into a new requisition system. Unfortunately, members wishing to return to their previous lab were denied when they contacted the above email, and they do not have the opportunity to opt out of the state-supported laboratory testing until December.

Also, Director of Aging Ursel McElroy asked us to reach out to members that did not complete the opt-in/opt-out survey. Here is a table of non-respondents. Director McElroy asked that these SNFs respnd to the survey, even if they wish to opt out entirely. Centers that did not respond were opted out automatically for the upcoming four weeks. The next opportunity complete the survey, as noted above, is December 1.

Self-Insured for Health Care? Let Us Know. Director McElroy is working on a mechanism to reimburse self-insured provider companies whose third-party administrators have paid claims for COVID-19 testing of facility employees. This applies to both SNF and assisted living companies. The Director is compiling a list of companies that could qualify for reimbursement. If your company is self-insured, please email Pete Van Runkle tomorrow.

We also recommend that you compile a detailed list of testing claims paid by your third-party administrator so you are prepared to submit whatever data are required when Director McElroy unveils the process.

Fifty-Three CMS Red Counties. Today the Centers for Medicare and Medicaid Services (CMS) released the weekly positivity numbers by county. The table show that 53 of Ohio's 88 counties now are classified as red on the CMS scale, twice as many as last week. A separate report of statewide positivity (percentage of COVID-19 tests that turn out positive) pushed over 12%. SNFs located in CMS red counties must test staff twice a week. They are not required to test residents twice a week. Resident testing in SNFs is required only in the case of an outbreak (potential exposure) or symptoms. Assisted living testing is not affected by the CMS county positivity numbers and remains at an every-two-week frequency.

Governor Addresses COVID-19 Vaccine Distribution. Also in his remarks today, Governor DeWine discussed how eventual COVID-19 vaccines will be distributed to Ohioans. He spoke of 10 regional "pre-positioning" centers that are all hospitals: Mercy Health St. Vincent Hospital, Cleveland Clinic, Metro Health Medical Center, Mercy Health - Springfield Regional Medical Center, Ohio State University Hospital, OhioHealth Riverside Hospital, Aultman Hospital, University of Cincinnati Medical Center, OhioHealth O'Bleness Hospital, and Genesis Hospital.

The Governor's comments, summarized below, seem to assume that the vaccine will require ultra-cold storage and do not account for yesterday's announcement from Moderna, which is making a vaccine that, if it receives an Emergency Use Authorization, would not necessitate that type of storage. The Governor's press release, however, is very encouraging relative to prioritization of long-term services and supports staff to receive vaccinations.

The Ohio Department of Health has identified 10 sites across the state that will receive the pre-positioned vaccine after a COVID-19 vaccine is given emergency-use authorization. Once the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices issues its recommendation on how to use the vaccine, these sites will begin administering the vaccine immediately to those who choose to receive it and are identified as able to receive it in the first stage.

Ohio will first vaccinate those who are most at risk, including those who work in long-term care facilities, nursing homes, and other congregate-care facilities, high-risk health care workers, and first responders.  

The ten pre-positioned sites were selected based on geography, population, and access to ultra-cold storage capacity. Other sites will begin receiving shipments of vaccine following final approval, potentially just days after the pre-positioned sites begin administering the vaccine.  

Governor DeWine once again encouraged citizens to remain vigilant in practicing safety measures until a vaccine is available.

Frequently-Cited OSHA Standards Relative to COVID-19. The Occupational Safety and Health Administration (OSHA) released a list of their standards that are cited most frequently for violations relating to COVID-19. These include the "big three" of respiratory protection plan, medical evaluations, and fit testing, along with several other standards such as reporting. The document also provides links to the relevant standards and to OSHA's consultation program.

NHSN To Update Reporting Pathways (from AHCA/NCAL). The National Healthcare Safety Network (NHSN) verbally announced there will be updates issued to two reporting pathways. The Resident Impact and Facility Capacity Pathway and the Staff and Personnel Impact Pathway will undergo a variety of changes in November.

These changes include: 

  • Removal of “SUSPECTED” section of reporting; 
  • Change from “CONFIRMED” to “POSITIVE TESTS” section; and 
  • Several additions, such as test type, re-infections, symptomatic/asymptomatic, non-COVID-19 respiratory illness, addition of co-infections (flu & COVID-19), and COVID-19 testing.
The details of when these changes will be issued has not been verified by the Centers for Disease Control and Prevention. AHCA/NCAL will provide an update when these updates have been made.

CMS Publishes List of SNFs Whose Staff Completed Training. CMS today issued a press release highlighting 7,313 SNFs that had 50% or more of their staff complete CMS's infection control training. CMS published a table showing these centers and urged others to follow suit. The release quotes CMS Administrator Seema Verma:

"We’ve provided nursing homes with $20 billion in federal funding, millions of pieces of PPE, free testing machines and supplies, and significant technical assistance and on-the-ground support,” said CMS Administrator Seema Verma. “Ultimately, the ownership and management of every nursing [home] must take it on themselves to ensure their staff is fully equipped to keep residents safe. With coronavirus cases increasing across the country and infection control identified as a major issue, we encourage all nursing homes to take advantage of this no-cost opportunity to train their staff."

Ohio SNFs that CMS lists as meeting the 50% standard can be found on pages 49-58 of the table.