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October 6, 2020


SNF Groups Discuss Issues with Governor DeWine. At Governor Mike DeWine's request, representatives of OHCA and the other state organizations representing SNFs had two conversations with the Governor and a number of other members of his Admininistration that totaled nearly 2 1/2 hours over the past two days. In these discussions, the Governor asked a number of questions and solicited input on providers' experiences and on how they are dealing with COVID-19. Naturally the dominant topic was testing, as the Governor indicated he is considering further changes to respond to the federal mandates and the advent of antigen tests. In addition to extensive comments on testing, in which we recommended scaling back outbreak testing and delivering BinaxNOW cards to SNFs with outbreaks, we touched on various other topics, including infection control and training, personal protective equipment, staff burnout, surveys, flu shots, and testing access for ID/DD providers.

New CMS Positivity Ratings for SNF Testing. The Centers for Medicare and Medicaid Services (CMS) released new county-level positivity ratings for SNF testing. Please see this table for Ohio counties. Two counties - Putnam and Richland - are red per the CMS ratings. This week, OHCA added to the CMS table a column showing the current (October 1) Ohio Public Health Advisory System (OPHAS) rating for each county and another column identifying counties that the state considers mismatches (green on CMS and red on OPHAS: Ashland, Clermont, Hamilton, Mercer, and Montgomery). Mismatch counties are colored yellow on the table because the state requires weekly testing like in yellow counties under the CMS system.

Additional PRF Phase 3 Materials; Webinar. Yesterday, the Department of Health and Human Services (HHS) portal for the Phase 3 General Distribution opened. Phase 3 is broadly applicable to all provider types eligible for Phase 1 (Medicare providers) or Phase 2 (Medicaid providers, including waivers, and private-pay assisted living). The primary purpose of Phase 3 is to compensate providers for lost revenue or increased expenses during the first two quarters of 2020 that were not covered by other distributions. Additional materials for the application include instructions, a model form (although the portal must be used for the actual application), and a revenue worksheet. Also important is HHS's revised frequently-asked questions for Phase 3. The deadline for application is November 6, 2020. HHS is offering a webinar on Phase 3 on October 15 at 3:00 p.m.

SNF/AL Visitation Order Still Not Published. Unfortunately as of this writing, the revised visitation order for SNFs and assisted living communities that Governor DeWine and Director of Aging Ursel McElroy announced almost two weeks ago still has not appeared on the Ohio coronavirus website. This order will permit indoor visitation. The order will take effect Monday, October 12, and all affected facilities will need to conform their visitation policies to the new requirements, so we are restating what we believe the order will say. We advise preparing your policy now based on this information, then adjusting if necessary after the order is published. The order probably will include the following:
  • Indoor visitation can take place in a space that is not used for another purpose while visits are occurring and is separate from resident areas.
  • Masking and social distancing will be required, as with outdoor visitation, and visitors will be prohibited from detouring or interacting with other residents.
  • The order will not prohibit visitation in red and purple counties under OPHAS. Instead, it will retain the current list of factors that facilities are to consider in setting their visitation policies. Flexibility for SNFs not to allow visits is restricted considerably by the federal guidelines, which require visitation except under prescribed circumstances.
  • The order will require facilities to enter information about their current visitation policies into a portal that will populate a publicly-accessible dashboard. The dashboard is not available yet.
  • Visitors will need to use facility-supplied facemasks instead of cloth face coverings.
  • The number of visitors will be limited to two at a time.
  • The minimum visitor age will be based on ability to maintain distancing.
  • Hospice staff performing core services, beauticians, and members of the clergy will be designated as essential personnel who are not subject to the visitation requirements.
  • The maximum length of a visit will be 30 minutes, counting only time the resident and visitor are together.
  • The compassionate care exception to visiting limitations will be expanded beyond end of life to comport with the federal guidance.

CMS: Routine Transport Personnel Must be Tested. Today, the Department of Health (ODH) shared guidance they received from CMS on whether medical transportation personnel serving SNF patient are subject to the COVID-19 testing requirements of Quality, Safety, and Oversight letter (QSO) 20-38-NH. The question is if these personnel are included in the contractors, consultants, and volunteers who are considered facility staff and, therefore, are subject to testing. Per ODH, CMS stated that they are, except in an emergency:

In accordance with the CMS Interim Final Rule CMS-3401-IFC included in QSO-20-38-NH, dated August 26, 2020, personnel who are providing non-urgent medical transportation (e.g., ambulettes, non-emergent EMS transports) are considered as providing services under arrangement.  Personnel providing services under arrangement should be tested by the facility or provide documentation that required testing was completed during the timeframe that corresponds to the facility’s testing frequency.

It is the facilities responsibility to offer testing and/or verify compliance with the requirement.

Individuals providing emergency services, such as EMS workers or law enforcement, are not required to show proof of testing and should not be delayed in responding to emergency situations. Additional questions concerning COVID-19 testing requirements should be referred to the Ohio Department of Health.

ODH reported that this and related topics will be included in an upcoming frequently-asked questions document.

SNF Resident Voting. CMS issued QSO 21-02-NH, which reaffirms the right of SNF residents to vote, despite the limitations caused by COVID-19, and explains the applicable regulatory requirements and various ways to facilitate the right to vote. In Ohio, the Secretary of State published a guide for voters with disabilities, set up as a myth vs. fact presentation, which contains the following section:

MYTH: Nursing home residents are not allowed to vote.

TRUTH: If a person has a disability and is confined to a public or private institution, the county board of elections can deliver a ballot to them. Two election officials of different political parties will deliver the ballot and return the ballot to the board of elections. Voting with a mail-in absentee ballot is also an option. Contact your local board of elections to receive details regarding their process.

The election officials mentioned in this statement are not considered visitors but government officials under the current and future visitation orders. They are subject to screening but must be allowed access. While the materials described above specifically refer to SNFs, the right to vote applies to people who live in other regulated facilities such as ICF/IID and assisted living communities.

Reminder: Project ECHO Introductory Webinars Start Tomorrow. To ensure all SNFs know about and participates in Project ECHO, the 16-week, federally-sponsored training program that includes a $6,000 stipend, the ECHO team scheduled 5 introductory webinars over the coming two weeks. These 30-minute webinars, which will be identical in content, are set for the following dates/times:

  • Wednesday, October 7, 12:30 p.m.
  • Thursday, October 8, 7:30 a.m.
  • Tuesday, October 13, 3:00 p.m.
  • Wednesday, October 14, 2:30 p.m.
  • Thursday, October 15, 12:00 noon
Please use this link to register for any of these webinars.

Abbott BinaxNOW Training. As HHS continues to distribute Abbott BinaxNOW antigen testing cards to assisted living communities and some SNFs, the company is offering additional training on their use. The HHS announcement about the training follows:

This note is to inform you that Abbott will be holding two educational webinars this week in support of their BinaxNOW COVID-19 tests. These webinars are designed to reinforce the Training Toolkit and highlight key points that should be kept in mind during BinaxNOW COVID-19 and NAVICA implementation. To register for either training, please use the links below.  

Wednesday October 7th from 4:00 EST – 5:00 EST: Registration link  

Friday October 9th from 4:00 EST – 5:00 EST: Registration link  

For additional training videos and documents, please visit the BinaxNOW™ COVID-19 Ag Card and NAVICA™ App Set-Up and Training portal.