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September 1, 2020

HHS Announces Funding for Private-Pay Assisted Living. The Department of Health and Human Services (HHS) today announced that as long rumored, they are allocating Provider Relief Fund (PRF) dollars to private-pay assisted living communities. The way they are doing so is by adding the assisted living providers to the existing Phase 2-General Distribution, which requires an application through the appropriate PRF portal. As with other Phase 2 distributions, the assisted living payments will be 2% of annual patient revenue. The deadline for assisted living communities to apply, like that for other Phase 2 applicants, is right around the corner: September 13, 2020. An applicant only needs to start the application by submitting their tax identification number (TIN) by that date. Assisted living providers who already received 2% of revenue through either phase of the General Distribution by virtue of Mediciad participation or having a common TIN with a Medicare provider will not receive additional funding.

Assisted Living, Home Health Reportedly to Receive Abbott Testing Cards from HHS. According to Assistant Secretary for Health Admiral Brett Giroir of HHS, as quoted in an Associated Press article, the agency intends to send assisted living communities and eventually home health agencies and seniors centers the recently-authorized, credit card-sized COVID-19 tests developed by Abbott Laboratories. HHS is purchasing 150 million of the tests from Abbott. The cards, which are a type of antigen test, deliver results in 15 minutes. In the article, Admiral Giroir did not give a date for the shipments to begin.

State to Hold Thursday Webinar on SNF Testing Program. By means of an Enhanced Infromation Dissemination and Collection (EIDC) notice this morning, the Health Department notified SNFs of a webinar at 11:00 a.m. Thursday on the state-mandated staff testing program. Although the notice does not give the reason for the webinar, we suspect it may have to do with the recent federal SNF testing rule and guidelines that take effect tomorrow. Here are the details as provided via EIDC:

Bulletin Title: Nursing home staff testing using the state supported process

Bulletin Details:

Who: nursing home administrators, DONs, and others conducting nursing home staff testing using the state-supported process

When: Thursday, Sept 3 from 11 AM – 12 PM.

Where: Register at: After registering, you will receive a confirmation email containing information about joining the webinar. Please note: all attendees must use computer-audio, no dial-in (telephone) option is available.

Clarification of Outbreak Testing in SNFs Under Federal Guidelines. Centers for Medicare and Medicaid Services (CMS) Quality, Safety, and Oversight (QSO) letter 20-38-NH establishes various circumstances under which SNF staff and residents must be given COVID-19 tests. One such situation is an outbreak, which CMS, following in the footsteps of the Centers for Disease Control and Prevention (CDC), defines as a single new case among either staff or residents of a SNF. In the event of an outbreak, the guidelines require testing all residents and staff. At different times, we mistakenly stated that the initial testing must be done within 3-7 days after the positive case is identified, but the guidelines do not give a specific time period for initial testing. The 3-7 days is for repeated testing after the first tests. The specific language of the QSO on this point is:

Upon identification of a single new case of COVID-19 infection in any staff or residents, all staff and residents should be tested, and all staff and residents that tested negative should be retested every 3 days to 7 days until testing identifies no new cases of COVID-19 infection among staff or residents for a period of at least 14 days since the most recent positive result.

The wording "upon identification," suggests initial testing should begin when the positive test result becomes known, but CMS does not give a definite starting or ending time. The QSO goes on to refer to CDC's "Testing Guidelines for Nursing Homes," which assert that, "[p]erforming viral testing of all residents as soon as there is a new confirmed case in the facility will identify infected residents quickly, in order to assist in their clinical management and allow rapid implementation of IPC interventions (e.g., isolation, cohorting, use of personal protective equipment) to prevent SARS-CoV-2 transmission." (Emphasis added.) This language, together with "upon identification" in the QSO, suggests that testing begin immediately or as soon as possible after the center learns of the positive result.

HHS Moves to Force States to Recognize POC Antigen Tests. Admiral Giroir of HHS issued guidance under the Public Readiness and Emergency Preparedness (PREP) Act that extends coverage under the act to the point-of-care (POC) antigen testing machines that HHS is distributing to most SNFs across the country. This coverage includes off-label use of the devices for screening testing in congregate health care settings. The guidance specifically states, "[t]his PREP Act coverage preempts any State or local provision of law or legal requirement that prohibits or effectively prohibits such licensed health-care practitioners from administering or prescribing FDA-authorized COVID-19 tests to symptomatic or asymptomatic individuals at congregate facilities." We hope to learn tomorrow of Ohio's reaction to this directive.

AHCA Resources for SNFs Implementing CMS Testing Guidelines.

This resource summarizes the QSO memos and the guidance established by CMS for testing and reporting. 

This resource is geared toward providers who are not routinely testing and need to quickly implement a testing program. 
AHCA will host a series of “office hours” with staff experts Dr. David Gifford, Courtney Bishnoi and Jill Sumner to briefly review the new requirements and guidance and answer any questions providers may have. The office hours are scheduled for September 2, 3 and 4 at 4 pm Eastern. Web-ex information is as follows: 
  • Join via web: Web-Ex Meeting Link   
  • Join via phone: 1-415-655-0003 
    • Meeting number (access code): 172 882 5865 
    • Meeting password: mUi2SxhjC56   
Quidel will be hosting a webinar for AHCA on Thursday, September 3 at 3 pm Eastern to explain how providers can conduct a high volume of tests in a short period of time using the Sofia2 batch testing functionality.  

This resource offers steps providers need to take when they receive their rapid point-of-care antigen devices from HHS.

Finally, AHCA has a list of labs that can provide testing with a 48-hour turnaround time.

McKesson Ready to Accept Orders for Quidel POC Test Kits. As reported in previous editions of SNF News Bites, skilled nursing centers that receive either Quidel or BD POC testing units from HHS can order additional testing supplies only through either McKesson or Medline. McKesson informed OHCA that they have Quidel test kits available and ready to ship to Quidel users on an allocation basis. McKesson is still awaiting test kits for the BD unit and will inform OHCA and their customers when they are ready to take orders. Members who have the Quidel unit are encouraged to contact their McKesson account manager or Jeff Mazer at immediately to arrange for additional testing supplies.

Considerations for Interpreting Antigen Test Results in SNFs. CDC created helpful guidance outlining considerations skilled nursing personnel should follow when utilizing COVID-19 antigen tests, including advice for when a confirmatory molecular/polymerase chain reaction (PCR) test should be considered. In addition, please take note of the "Considerationa for Interpreting Antigen Test Results in Nursing Homes" flow chart, which provides easy-to-follow guidance for staff. All SNFs should familiarize themselves with this guidance as more COVID-19 POC antigen units arrive in Ohio facilities.

Ohio Liability Protection Legislation Finally Moves; Effective Date Delayed. The House of Representatives returned to legislative action today for the first time since ousting former Speaker Larry Householder (R-Glenford) from that position, although he returned for today's session. The House session was cut short by partisan issues, but the lower chamber did refuse to concur in Senate amendments to House Bill 606, a measure that protects OHCA members and other businesses from liability for COVID-19-related claims. A hastily-convened conference committee resulted, and the House adopted the committee's report on a party-line vote. The Senate is expected to adopt the report tomorrow. The conference report changed the Senate-passed legislation by extending the sunset of the liability protection provisions to September 30, 2021, and by stripping out the bill's emergency clause. While the extension is helpful because of the uncertain duration of COVID-19, removal of the emergency clause has the unfortunate result of delaying HB 606's effective date until 90 days after Governor Mike DeWine signs the legislation.

Indoor Visitation Guidelines Nearing Completion. Today representatives of the DeWine Administration and stakeholders met to address indoor visitation at various types of health care facilities, most notably SNFs, assisted living communities, and ICFs/IID. Ginnie Whisman of the Department of Developmental Disabilities (DODD) reviewed for the group the draft guidelines for indoor visitation in ICFs, which will implement an order that for the first time will be separated from the order applicable to SNFs and assisted living communities. We reported on the DODD guidelines yesterday, and stakeholders will discuss them tomorrow. The remainder of the meeting focused on the Department of Aging's draft revisions to the SNF/assisted living portion of the existing visitation order. The two most significant changes are a requirement that facilities stop visitation if the county where the building is located moves into a red or purple status under the Ohio Public Health Advisory System and a requirement that visitors wear facility-supplied surgical masks instead of cloth face coverings. There will be further conversations before the revised order is finalized. The effective dates for indoor visitation in the different settings have not been determined.

NHSN Reporting Changes. The National Healthcare Safety Network (NHSN) portal for reporting COVID-19 data has four new questions that relate to POC devices. NHSN reporting is mandatory only for SNFs and optional for assisted living communities and ICFs/IID. Only SNFs are likely to have POC units. The four new questions ask if the facility has a POC unit, how many tests were done on staff and residents, and whether the facility has enough supplies for the unit. Please note that when you complete the new questions, we understand the system changes the reporting format for the last few weeks to include the new questions, which did not exist when you originally reported. This renders the previous weeks' reporting incomplete until you go back and answer the four questions for each affected week. Presumably this automatic function occurs because some SNFs received POC devices in the past.