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October 29, 2020

Corrected Link for NHSN POC Reporting Training. There was in incorrect link in yesterday's article about training for SNFs on using the new National Healthcare Safety Network (NHSN) tool for reporting COVID-19 point-of-care (POC) test results. The error was for the November 2 training. The correct link is

Staggering COVID-19 Case Counts. Ohio blew by the previous record with 3,590 COVID-19 cases today, 700 more than the previous high. Lest anyone think the higher numbers are simply the result of more testing, there were 194 new hospitalizations. This is the third-highest number ever. The Ohio Public Health Advisory System continued to show the effects of the coronavirus surge, with half of Ohio's counties designated as red and only two remaining yellow. Cases in long-term care settings also skyrocketed, rising 68% to 2,565 in just two weeks.

Federal Government Warns of Ransomware Attacks on Healthcare Providers. The Cybersecurity and Infrastructure Security Agency (CISA), Federal Bureau of Investigation (FBI), and Department of Health and Human Services (HHS) issued an alert informing healthcare providers of ransomware targeted at healthcare. The agencies wrote, "CISA, FBI, and HHS have credible information of an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers. CISA, FBI, and HHS are sharing this information to provide warning to healthcare providers to ensure that they take timely and reasonable precautions to protect their networks from these threats." The alert explains in detail how the ransomware operates and possible mitigation steps.

COVID-19 Vaccination Planning: Healthcare Providers Can Enroll to Become Vaccine Providers. On Tuesday, we published information about a state-run effort to enroll providers to administer an eventual COVID-19 vaccine. This program would apply to long-term services and supports (LTSS) staff and is different from the Pharmacy Partnership for Long-Term Care, which is a federal initiative targeted at facility residents. We pointed out in the previous article that the Governor's Office recommends any LTSS provider potentially interested in vaccinating their staff (assuming it is feasible with whatever vaccine is approved) should sign up. Here is a notice from the state with more information on this topic:

In anticipation of a safe and effective COVID-19 vaccine, the Governor’s Pandemic Recovery and Response Leadership Team has created a Vaccine Preparedness Office to coordinate a smooth and swift distribution and vaccination process statewide. We are closely monitoring guidance from the Centers for Disease Control and Prevention (CDC), Operation Warp Speed, and the U.S. Food and Drug Administration on the status of each vaccine candidate and are hopeful that one or multiple vaccines might be authorized in the coming weeks and months.

Once a vaccine has been authorized, Ohio expects to receive shipments allocated by the federal government with guidance to first vaccinate high-risk populations including healthcare workers and older adults. In preparation for receiving a vaccine, Ohio has launched an inter-agency working team in collaboration with partners to create and execute a comprehensive vaccination program. A recorded webinar about the Ohio COVID-19 Vaccine Program and how you can participate is available at

We have launched a provider enrollment process with the goal of registering all interested vaccine providers in the coming weeks. A “job aide” is attached explaining how to complete a Vaccination Provider Program application, as well as an enrollment checklist. CDC offers an FAQ about COVID-19 vaccination at

Testing Clarifications. Please note that is no longer the right email address for questions about either the SNF or the assisted living testing program. The correct address is

Some members question the title of the state testing guidelines for SNFs, "Director’s Order for the Testing of the Residents and Staff of all Nursing Homes," wondering if it means all SNF residents must be tested routinely along with staff. The answer is no. While residents - even all residents - must be tested in certain circumstances, that is not the case for routine testing. Slides 11-14 of the guidelines make it clear that residents only need to be tested if they are symptomatic or in case of an outbreak.

HHS Updates PRF FAQs, Especially on Reporting. HHS published an extensively revised version of their frequently-asked questions (FAQs) on the Provider Relief Fund (PRF). The amendments bear yesterday's date, October 28. Most of them have to do with reporting use of funds and how to calculate expenses, lost revenue, etc. They incorporate the reporting requirements that were updated October 22, but elaborate on them considerably. The new FAQs address a few other things as well, including a chart on changes of ownership and confirmation that Phase 3 General Distribution funding is not limited to covering expenses and lost revenues for the first two quarters of 2020 but can be used through June 30, 2021, even though the award is calculated on the first two quarters of 2020.

Leftover Chat Items from Tuesday's SNF Call. On our Zoom call for SNF members Tuesday afternoon, there were a few questions and comments that we did not have time to address. Here are some of them.

  • If we are in a CMS red county and are in outbreak status, do we have to test the residents 2x/wk or can we continue to test the residents every 7 days and only test the staff 2x/wk? No, you only have to test the residents every 3-7 days after the initial outbreak testing.
  • In regard to the NHSN lab reporting, if our SNF does not have its own CLIA waiver (we are part of a hospital), do we have to report testing that is performed by our hospital lab, or does the lab continue to report as they currently are? The lab continues to report, but will have to comply with the new line-level reporting requirement.
  • If we are in outbreak status, are we allowed to take new admits, if the new admit is aware of outbreak status and is ok with still coming? There is no state or federal prohibition on taking new admissions when in outbreak. Some local health departments may direct a hold on admissions.
  • On compassionate care visits, we stated in our policy that it would be an interdisciplinary team decision including our Medical Director's and/or NP's advice.
  • We get local ombudsman involved if there is push back on not permitting compassionate visitation. Both of these are good suggestions. The state and federal guidance specifies, "[t]hrough a person-centered approach, Homes should work with residents, families, caregivers, resident representatives, clinicians and the Office of the State Long-Term Care Ombudsman program to identify the need, length, and frequency for compassionate care visits." We recommend flexibility with compassionate care visits, so long as the family does not abuse the privilege (substitute for routine visits) or flout infection control rules.
  • As long as a facility is able to continue to test with only PCR testing and has good turn-around times, we are not required to report anywhere except NHSN weekly, local weekly, local immediately if a positive? Correct, although there is no state or federal requirement for reporting weekly to the local health department, and there are also the family notification requirements.