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October 17, 2020

HHS COVID-19 Vaccine Distribution Plan. The Department of Health and Human Services (HHS) announced yesterday afternoon a plan for distributing free COVID-19 vaccinations to long-term care facility residents. The distribution will be managed by CVS and Walgreens, apparently with involvement by their institutional pharmacies, Omnicare and Pharmerica. Facilities must register for this program through the National Healthcare Safety Network (NHSN) or an online form. Registration will open Monday and continue for two weeks. Neither registration site is available yet.

Providers participating in NHSN received an email on the vaccine distribution program that attached an overview and a frequently-asked questions (FAQ) sheet. These attachments have the most comprehensive information. HHS issued a news release announcing the distribution plan, and AHCA/NCAL emailed an update and posted an article promoting it. Provider associations also received a 30-minute, national briefing that essentially reiterated the news release and answered a handful of questions. AHCA/NCAL scheduled a series of office hours sessions for members, starting at 3:00 p.m. on Monday, that will include Ruth Link-Gelles from the Centers for Disease Control and Prevention (CDC), who was the subject-matter expert for yesterday's briefing.

Here are some frequently-asked questions with answers based on what we know today.

Q. When will residents be vaccinated under this plan?

A. Probably early 2021. No COVID-19 vaccines have received emergency use authorizations, but one or more could be granted before the end of the year, depending on clinical trial results. The federal government already has purchased hundreds of millions of doses of multiple vaccines for distribution once authorization is granted. See this vaccine tracker for details on their status and this resource for general information about COVID-19 vaccines.   

Q. Which providers are included?

A. Not altogether clear. Skilled nursing centers and assisted living communities are the only facility types listed in the HHS overview and FAQ and are the only ones that have defined ways to sign up. The HHS news release adds "residential care homes, and adult family homes," while the AHCA/NCAL update adds "ICF/IIDs and other congregate settings for older adults." The NHSN email lists independent living along with SNFs and assisted living. We expect the program's applicability will be clarified in the days to come.

Q. Is this program just for residents, or can staff be vaccinated through it as well?

A. Per HHS: "It is possible that staff will be eligible to receive COVID-19 vaccine earlier than LTCF residents as part of a recommendation for vaccination for healthcare personnel, including those in LTCFs. Any staff member who was not already vaccinated could be vaccinated through these on-site clinics; however, we strongly encourage staff to be vaccinated as soon as they are eligible, which may occur through mobile clinics and clinics run by health departments for healthcare personnel."

Q. Is this mandatory?

A. No, but HHS emphasizes that this distribution plan is free to the facilities and ensures compliance with all requirements, most notably cold-chain management and extensive line-level reporting. If a facility obtains vaccines through their existing pharmacy, the pharmacy and facility would have to meet those requirements.

Q. Does this announcement mean our residents are first in line to receive the vaccine?

A. No. As shown in this CDC plan and slide deck, health care personnel (including long-term services and supports) are in Phase 1a of vaccine distribution and residents and other high-risk individuals are in Phase 1b.

Q. I have heard about local planning for vaccine distribution. How does this announcement relate to those activities?

A. Not altogether clear. The HHS program appears to be separate from the local planning efforts. We understand that states were required to submit their vaccine distribution plans to CDC yesterday, but Ohio's plan is not publicly available at this time.

Visitation Dashboard Updates. The visitation dashboard for SNFs and assisted living communities is not yet visible to families or the general public, as it is scheduled to go live on Monday, but you can see how it looks so far here. If you click in the farthest right-hand column for any listed facility, a more detailed view appears.

Yesterday afternoon, the Health Department's (ODH's) Rebecca Sandholdt posted the following notice about the visitation portal on the Enhanced Information Dissemination and Collection System (EIDC):

A few important updates regarding facility visitation:

1. If you have entered visitation times and need to make updates, you are now able to do that

2. Use google chrome for all applications

OHID account and facility registered are done via 2 separate systems

OHID:  CLICK CREATE OHID ACCOUNT: If the email used to set-up the account is different than the email used when registering the facility email, and

Facility Registration:

Adding the LTC facility visitation app to your OHID account is not done automatically once you submit Approving your facility is not done automatically once you submit We cant add the app with out the OHID account and you wont be able to see your facility in the app unless you have registered your facility and we have performed approvals

Please ensure that you have registered your facility and have established an OHID account, allow my team and I 12-24 hours to perform the approvals prior to emailing us for assistance.

COVID-19 Laboratory Reporting. For anyone who administers antigen COVID-19 tests either using a point-of-care machine or BinaxNOW cards and missed yesterday's webinar on the new ODH authenticated web portal for line-level reporting of test results, the key information is available on this ODH web page. The page includes the comma-separated values (CSV) format to be used for this reporting option as well as instructions for registering, which is similar to registering for the ODH laboratory portal for testing or the visitation portal.

In yesterday's webinar, ODH's Bill Storm said a new laboratory reporting order should be out any day. Providers performing on-site COVID-19 testing will have two options for reporting: ODH or NHSN. The NHSN pathway, which is coming soon, will be covered in two training webinars scheduled for next Thursday and Friday. See NHSN's long-term care reporting page to participate in these webinars (scroll down to Upcoming Trainings).

Updated AHCA Fact Sheet on Three-Day Stay Waiver. AHCA updated its fact sheet on the SNF three-day stay and spell of illness waivers to reflect the 90-day extension of the Public Health Emergency that underlies the waivers. The fact sheet is a detailed, 7-page explanation of all aspects of the waivers and is well worth downloading and reviewing to refresh your undertanding of these important provisions.

Adult Day Updates. The Department of Aging disseminated the following notice about the time-limited opportunity for providers of adult day services for seniors (not adult day services through the Department of Developmental Disabilities) to receive payments from the state's Coronavirus Relief Fund:

The State of Ohio is distributing Coronavirus Relief Funds provided to the state from the US Department of Treasury as part of the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act").  The Ohio Department of Aging is accepting applications to provide critically needed economic support and grants to Adult Day Service Facilities and Senior Centers who were impacted by public health orders and increased costs due to the pandemic. These funds will be distributed through the Ohio Office of Budget and Management at the direction of the Ohio Department of Aging. 

The COVID-19 pandemic has impacted providers across our state, and these payments are therefore necessary expenditures to compensate for business interruptions and to comply with health orders and related response activities necessary due to the public health emergency. Adult Day Service Facilities and Senior Centers were required to discontinue in-person service delivery in March 2020 pursuant to the Health Director's order. On August 31, 2020, the Director of the Department of Health issued a revised order permitting facility based services to begin on September 21, 2020 if they meet certain safety standards, including reduced capacity and spacing, sanitation, signage and communication, facility standards, activity requirements and staffing protocols. Both types of facilities were impacted during the pandemic due to the high degree of susceptibility to COVID-19 and the congregate nature of the services provided to the public. Providers in this sector have incurred significant losses, continue to incur losses, and are experiencing additional costs due to the pandemic. Providers that are Adult Day Service Facilities and Senior Centers should apply for each separately. 

The application period is open from Oct. 16-31, 2020. Please see the attached memo from Ohio Department of Aging Director Ursel McElroy for details.

Visit the Adult Day Centers and Senior Centers COVID-19 resources page on our website for additional information.

Also, the Director of Health issued an amended version of the reopening order for adult day services and senior centers. Per Director of Aging Ursel McElroy, the changes clarify that there are no exceptions to the requirement that participants wear facemasks and that participant testing is per the department's guidelines, which do not mandate testing for senior center participants. The new order also changes the recommended self-screening tool.