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October 28, 2020

Pharmacy Partnership for Long-Term Care Deadline Extended. The Department of Health and Human Services extended the deadline for long-term care facilities to register for the Pharmacy Partnership for Long-Term Care. The Partnership will ensure facility residents receive COVID-19 vaccinations at on-site clinics run by either Walgreens or CVS. Although the timing of vaccine distribution is unclear, we urge all facility members to sign up for this program so their residents can b vaccinated when a vaccine become available.

To register:

  • SNFs use the National Healthcare Safety Network (NHSN). Log into the portal you use to report COVID-19 case data. A pop-up should appear for you to sign up for the Partnership. If you do not see a pop-up, a link for the Pharmacy Partnership should be on the upper right side of the page.
  • Assisted living communities, ICFs/IID, and waiver group homes sign up using this RedCap survey.

For questions, email

Stop SNF Indoor Visitation in Red Counties. As red counties proliferate in Ohio, under both the Centers for Medicare and Medicaid Services (CMS) and the state measures, we receive more questions about stopping indoor visitation. Until today, OHCA interpreted CMS Quality, Safety, and Oversight letter (QSO) 20-39-NH as permitting, but not requiring, SNFs to suspend visitation in CMS red counties. Others read the QSO as requiring indoor visits to cease, except for compassionate care situations. We understand CMS is developing a set of frequently-asked questions on visitation, but it is not available yet. In the meantime, to clarify the situation, we inquired of the Health Department's (ODH's) Jill Shonk about the impact of CMS red county status on indoor visits. She wrote, "[a]ccording to the memo [QSO] they could continue compassionate care visits but not routine indoor visits."

We advise all SNF members in CMS red counties (see table) immediately to stop indoor visitation until either the county goes to yellow or green or CMS issues a different interpretation. In addition to compassionate care visits, outdoor visits still can be done in red counties.

This prohibition also does not apply to either assisted living communities or ICFs/IID, which are not governed by the QSO but by state visitation orders (order covering ALs, order covering ICFs), both of which require facilities to consider COVID-19 prevalence in the community but do not mandate cutting off visitation at any specific color level.

Testing on a Shared Campus. With two different COVID-19 testing systems for SNFs and assisted living communities, there are questions about how the two programs work when a SNF and assisted living are in the same building or on the same campus. In the state's opt-in/opt-out survey for SNFs, which is due November 6, there is a single question about whether the SNF is on a shared campus. The state's SNF testing guidelines elaborate somewhat on the purpose of this question (see slides 26-28). The first step, accomplished via the survey, is to identify the shared campuses. The second step is to "[a]lign testing dates, labs, and supply delivery as practicable." While it is not clear how this alignment will look, we suspect it will involve adding the assisted living staff to the SNF schedule for the weeks when polymerase chain reaction (PCR) tests are in place (every other week) and using the laboratory assigned to the SNF instead of MAKO to do the testing for the assisted living staff. We will keep you posted as we learn more about the state's plans in this area over the next couple of weeks.

Clarification of Line-Level Test Result Reporting. A number of members ask about the applicability of the new requirement for long-term care facilities to report COVID-19 test results at the line level, specifically whether they must report results from PCR tests performed by outside laboratories. The answer is no. The reporting requirements apply to laboratories. A facility is considered a laboratory only for tests it performs on site under a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver. For COVID-19, these tests are point-of-care (POC) antigen tests, either using a BinaxNOW card or a BD or Quidel machine. The facility functions as a lab because it performs the test on site, so it must report these test results. When the test is conducted in another location, as is the case for PCR tests, the facility is not the laboratory. The site that actually performs the test must do the line-level reporting.

Another question about the reporting requirements is whether an assisted living (AL) community that uses POC tests is mandated to report through NHSN, as discussed below relative to SNFs. AHCA/NCAL wrote today, "[w]e received clarity from CMS that this requirement only applies to SNFs, and not ALs. ALs can still report to either the state or NHSN to meet the POC test reporting requirement." In Ohio, the state process is through the ODH electronic laboratory reporting program.

ODH on N95 Crisis Capacity. When a SNF is in crisis capacity for N95 respirators, ODH staff gave the following direction:

  • A KN95 is better than no mask, but KN95s that are not on the authorized use list may be less effective than a surgical mask.
  • A staff member can go from a clean area to a quarantine unit to a COVID-19 unit, then dispose of the personal protective equipment.
  • An N95 has to "rest" for 72 hours before it can be worn again.
  • The maximum number of uses for an N95 is 5, or fewer if it is contaminated or damaged or the seal doesn't work. (Note: the Centers for Disease Control and Prevention (CDC) guidelines on this topic specify, "[t]o reduce the chances of decreased protection caused by a loss of respirator functionality, respiratory protection program managers should consult with the respirator manufacturer regarding the maximum number of donnings or uses they recommend for the N95 respirator model(s) used in that facility. If no manufacturer guidance is available, preliminary data suggests limiting the number of reuses to no more than five uses per device to ensure an adequate safety margin.")
  • In a quarantine area, a staff member can put a surgical mask over an N95, then when going to the next patient, clean their face shield if necessary and change the surgical mask, while leaving the N95 in place.

CDC defines crisis capacity as follows: "Facilities can consider crisis capacity strategies when the supply is not able to meet the facility’s current or anticipated utilization rate." ODH's Rebecca Sandholdt warned that saying you are in crisis capacity and being in crisis capacity aren't the same, for instance if the facility in fact has a stock of N95s. Ms. Shonk said a SNF could document attempts to obtain N95s through, for example, frequent outreach to the center's vendor, the local emergency management agency, the local health department, and sister facilities. According to CDC guidelines, however, "[s]ome healthcare facilities may wish to implement extended use and/or limited reuse before respirator shortages are observed, so that adequate supplies are available during times of peak demand." This statement indicates that the guidance is not limited to crisis capacity situations, but also can be used to preserve a potentially fragile supply.

Governor DeWine Requests BWC Send $5 Billion Dividend to Ohio Employers. Per the release following Governor Mike DeWine's press conference today:

Ohio Governor Mike DeWine was joined by Lt. Governor Jon Husted today to request the Ohio Bureau of Workers' Compensation (BWC) send up to $5 billion in dividends to Ohio employers to ease the continued financial impact from the COVID-19 pandemic.

‘This pandemic is unprecedented, and continues to financially impact Ohio employers and businesses,” said Governor DeWine. “Issuing these dividends is important. This is about keeping businesses open and people employed.”

If approved by BWC’s Board of Directors, it would bring the total dividend dollars for employers this year to nearly $8 billion. 

“As Ohio businesses confront the economic challenges of a COVID world, this kind of financial relief can be the difference between closing and staying open,” Lt. Governor Husted said. “We don’t want Ohio businesses and the jobs they create to be a casualty of the pandemic.”

The $5 billion dividend would be BWC's third dividend of more than $1 billion this year, and the largest one-time dividend ever issued by the BWC. BWC distributed $1.54 billion in April and $1.34 billion in October. At $5 billion, this dividend is approximately four times the total premiums BWC collected from its employer members in policy year 2019.

“We’ve never issued three dividends in the same year, let alone any for this much, but unprecedented times call for unprecedented actions,” said BWC Administrator/CEO Stephanie McCloud. “Even so, the State Insurance Fund is well positioned to cover our injured workers for years to come.”

Despite the pandemic, BWC remains in a strong fiscal position from healthy investment returns on employer premiums, a declining number of claims each year, and prudent fiscal management. 

Private and public employers in Franklin County would receive approximately $559 million, followed by Cuyahoga County at $528 million. The employer in line for the single largest dividend check in the state is the city of Columbus at nearly $64 million.

BWC’s Board of Directors is tentatively scheduled to vote on the request during a special meeting on Monday, November 2, 2020.  Please check to confirm Board details.

Funded by employer premiums, BWC provides workers’ compensation insurance to approximately 245,000 private employers, and 4,000 public employers, such as cities, counties, and schools.

NHSN Announces Training on Line-Level Reporting. Yesterday, NHSN opened their mandatory Long-term Care Facility COVID-19 Point of Care (POC) Test Reporting Tool for SNFs and any assisted living communities participating in NHSN to submit line-level POC testing data, but training on the Tool was not available at the time. That changed today with an announcement from NHSN of two upcoming training sessions. The first will be live, the second will be a recording of the first session with live questions and answers.

The first session is Friday, October 30, from 2:00-3:00 p.m. Use this link to register.

The second session is Monday, November 2, from 12:30-1:30 p.m. Use this link to register.