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September 21, 2020

Aging Reposts AL Testing FAQ. The Department of Aging reposted their frequently-asked questions (FAQ) on the state assisted living testing program after a brief absence. The material was reformatted, but appears to be substantively the same as before, except for removal of the answer that suggested residents must be tested every two weeks. Unfortunately, the department did not clarify yet payment arrangements for staff testing. The answer still reads, "[t]he State is the payer of last resort for those facilities participating in state-supported testing. While reimbursement from third-party payers will be sought whenever possible, neither the person being tested, nor the facility will be charged for testing." The FAQ does not explain how this commitment will be met if the community is self-insured for health care.

Midnight Deadline for AL Funding. According to NCAL, tonight at midnight is the deadline for private-pay assisted living providers to apply for funding under the Provider Relief Fund Phase 2-General Distribution. All that is necessary to meet the deadline is to submit your Tax/Employer Identification Number for verification in the Phase 2 portal.

Apply for a CLIA Certificate of Waiver to Receive Abbott BinaxNOW Cards. As members are aware, the Department of Health and Human Services (HHS) began another initiative to supply providers with antigen testing capability by shipping Abbott BinaxNOW COVID-19 Ag Cards to SNFs and assisted living communities. All assisted living communities potentially are able to receive the cards, but only if they are eligible to perform point-of-care COVID-19 testing under a CLIA (Clinical Laboratory Improvement Amendments) Certificate of Waiver. While most SNFs in Ohio have a CLIA Certificate of Waiver, many assisted living communities do not.

Fortunately the application process is relatively simple and, accordingly to the Department of Health (ODH), the application often can be processed the same week it is received, depending on the number of applications submitted that week. ODH also shared that because the CLIA database is updated overnight, new CLIA-approved facilities will show up immediately when HHS runs the daily reports. All assisted living members interested in receiving the complimentary BinaxNOW cards should review this brochure, which explains how to complete a CLIA application. The type of CLIA certificate you should request is a Certificate of Waiver. Once you complete it, you will need to send your application directly to ODH via mail or by email at To learn more about CLIA laboratory certification through ODH, please click here.

State to Announce SNF Testing Program Changes. ODH circulated a notice on the Enhanced Information Dissemination and Collection System (EIDC) informing SNFs that the state plans to reveal changes to its testing program to align it with the CMS testing requirements. The notice specifies that the state will hold a webinar on Wednesday, September 23, from 9:00-10:00 a.m., to explain the changes and the state's plans to continue supporting SNFs in meeting the requirements. Please use this link to register for the webinar (yes, there really is registration for this one).

CMS Provides SNF Testing Payment Flow Chart. The Centers for Medicare and Medicaid Services (CMS) published a flow chart and payer hierarchy for paying for testing in SNFs. While the material, particularly the flow chart, refers to patients and residents, it also would apply to staff members who are covered by the relevant payer. CMS clarifies that Medicare covers outbreak testing and baseline testing for reopening for asymptomatic beneficiaries, but not testing for public health surveillance. Relative to private health insurance, CMS writes, "[h]ealth insurance issuers and group health plans must cover COVID-19 diagnostic testing as determined medically appropriate by the individual’s health care provider, consulting CDC guidelines as appropriate. Health insurance issuers and group health plans are not required to cover non-diagnostic tests (i.e., testing done for public health surveillance purposes) without cost-sharing."

CMS National SNF Call. On a quickly scheduled national SNF call today, representatives from CMS and the Centers for Disease Control and Prevention (CDC) discussed visitation under Quality, Safety, and Oversight letter (QSO) 20-39-NH and testing under QSO 20-38-NH. CDC announced that on Thursday, it will unveil new provisions for weekly reporting on flu vaccine by SNFs to the National Healthcare Safety Network (NHSN). A few points of interest from the call:

  • CMS confirmed that SNFs can use alternative county positivity rates to set their routine testing frequency if the rates are determined officially by a state or county using a similar methodology to CMS. The provider must document the source of the data, the date it is retrieved, and the positivity rate itself.
  • Contractors can be tested by someone other than the SNF. The facility must obtain documentation that the testing was done during the facility's timeframe under the CMS guidelines.
  • Staff or contractors who have irregular schedules or are not present for the SNF's normal testing frequency should be tested when they next enter the facility.
  • CMS's Evan Shulman gave unclear answers when asked whether required visitation must include indoor visitation. It did not appear that CMS unequivocally requires indoor visitation when outdoor visitation is available, particularly when, as in Ohio, a state order only allows outdoor visitation.
  • The upcoming NHSN flu reporting is not mandatory.
  • CMS's Dr. Lee Fleisher supported the CDC algorithm for determining when additional polymerase chain reaction (PCR) testing should be done to confirm an antigen test result. The algorithm is not mentioned in QSO 20-38, so Dr. Fleisher's endorsement confirmed CMS's intent to follow it.
  • CMS strongly encourages testing visitors, but it is not required. CMS agrees with allowing beauticians into facilities if they are tested.
  • Mr. Shulman viewed the CMS guidance as requiring broad testing of contractors, but pointed to language in QSO 20-38 giving priority to contractors who have close contact with patients. As an example, he said a person making a quick delivery would not need to be tested.