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September 23, 2020


State Rolls Out Revised SNF Testing Program. The state held a webinar this morning to explain changes they are making to the state-supported testing program for SNFs to align it with the Centers for Medicare and Medicaid Services requirements. These changes will take effect October 5. In the meantime, the existing state testing schedule will remain in effect. The state announced in the webinar that they support antigen testing in SNFs. They are eliminating nearly all of the state testing mandates, but will require green counties under the federal system that are red or purple under the Ohio Public Health Advisory System (mismatch counties) to test weekly insead of monthly. We opposed this feature when the state introduced it two weeks ago, but they chose to retain it.

The state will offer support, like the current state testing system but optional, to centers in red, yellow, or mismatch counties, as well as to centers experiencing an outbreak. The optional state-supported testing will be weekly for red counties and biweekly for yellow and mismatch counties and oubreaks. Initial testing will not be included for outbreaks. The Department of Medicaid's Marisa Weisel, who presented the bulk of the webinar, said state support will include the state serving as payer of last resort for the state testing, but she did not explain what that means.

The state will introduce a new Survey Monkey for the revised process by which centers can opt in or out and can list the number of tests needed. The Monkey must be completed by Monday, September 28, at 9:00 a.m. Ms. Weisel said the state will post a preliminary testing schedule this Friday, with the final by September 30. She also commented that going forward, specimens received by the lab outside of the schedule or with hand-written requisition forms will not be processed. The state intends to post the slides from the webinar and revised frequently-asked questions and guidance on the testing web page, but they are not there yet. 

ICF Indoor Visitation. Department of Developmental Disabilities (DODD) Director Jeff Davis confirmed that indoor visitation will be allowed for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) beginning September 28. OHCA will share the revised order and guidance as soon as we receive them. 

DODD Acuity C Rate Extension. Today, DODD in conjunction with the Ohio Association of County Boards (OACB) announced that the county boards will continue to fund acuity C rates for day services through December 31, 2020. OACB was clear that this will be the final extension of their financial commitment. DODD will reconvene a stakeholder workgroup that met in the spring to help revise the department's guidance for day services. The group will discuss recommendations for changes to the current order and funding to allow more individuals to resume activities during the day by the beginning of 2021.

Assisted Living Testing Schedule Not Available Yet, Survey Deadline Extended. Originally set for yesterday, the assisted living testing schedule was postponed to today on the Department of Aging (ODA) web page, but it is not out as of this writing. Instead, ODA sent an email to licensed residential care facilities extending the deadline to complete the scheduling survey. The message read:

Thank you for your patience and ongoing commitment to Ohio’s older adults.  As you may know, the Ohio Department of Aging recently held webinars on Friday, September 18th to explain the testing requirements for reopening.  During the webinar, we also announced the state’s partnership with MAKO Medical which will provide COVID-19 testing to residential care facilities, adult day services and senior centers in accordance with each respective Director’s Order.

Every facility is asked to complete a quick survey to register (opt-in) for state-supported testing or to decline (opt-out of) state-supported testing if the facility is utilizing another testing option.   If you have not already taken the opt in/opt out survey, please take it now.  The survey will remain open through 11:59 PM on Friday, September 25th.  Please designate one point of contact from your facility/center to complete the opt-in/opt-out survey by the deadline.  Please fully complete the survey and click “DONE” to record your selection.  Completion of this survey is needed to create the testing schedule and to ensure the bi-weekly delivery of testing supplies to facilities that opt-in for state-supported testing.

By opting in, MAKO will provide necessary testing supplies, paid Fed Ex shipping, and lab processing.  There is no expectation for a facility to utilize the state-supported program to meet the requirements of the Order.  Facilities are permitted to continue using testing programs/processes that are currently in place or are being independently secured.   Regardless of the testing choice, every facility is required to report its test results every two weeks to the Ohio Department of Aging.

Please visit the residential care facility or adult day services/senior center pages of our website for further program guidance and information.  If you have additional questions that these resources do not answer, please feel free to contact the testing team directly at COVIDTesting@age.ohio.gov.

Note for Senior Centers and Adult Day Service Centers:  If you plan to reopen in the next two weeks, please use the survey to register if you wish to use state-supported testing.  If you plan to open at a later time, please reach out directly via email to MAKO at RNibert@makomedical.com or JTucker@makomedical.com to opt into the testing program.

Eye Protection in SNFs. We learned from OHCA legal counsel Rolf Goffman Martin Lang and others that Health Department (ODH) surveyors told some SNFs in counties defined as orange or red by the Public Health Advisory System that staff must utilize eye protection (goggles or face shields) when caring for all patients, not just new admissions, readmissions, and COVID-19-positive patients. The surveyors apparently rely on general Centers for Disease Control and Prevention (CDC) guidelines for health care personnel for this proposition instead of looking to the specific CDC guidance for SNFs, which does not require eye protection in all cases. OHCA wrote to survey leadership at ODH seeking clarification of the department's position.

Approved and Counterfeit N95s/Authorized and Non Authorized KN95s; Where to Turn? It has come to OHCA's attention that surveyors are beginning to ask providers if the respirators they are utilizing are on the “approved list.” Please note that the National Institute for Occupational Safety and Health (NIOSH) only approves N95s. Here is the link to find the list of NIOSH-approved N95s. The list begins with 3M and goes alphabetically through all manufacturers with NIOSH-approved N95s. Please note that the list contains N95s with and without valves. Healthcare providers treating airborne viruses like COVID-19 must use N95s without valves. NIOSH also created a page highlighting counterfeit N95s that unfortunately have entered the US market. We encourage members to check the link for this page and to bookmark it for future reference. 

KN95s, on the other hand, are not NIOSH-approved and only are authorized for use by the Food and Drug Administration (FDA) during this pandemic. Moreover, providers should use KN95s only when N95s are unavailable. According to CDC guidance on this topic:

Non-NIOSH-approved products developed by manufacturers who are not NIOSH approval holders, including only products approved by and received from China, should only be used in crisis situations when no other NIOSH-approved N95 respirator (or a listed device from one of the other countries identified within the FDA EAU) is available; they should not be used during aerosol generating medical procedures unless the alternative is a loose-fitting surgical mask or improvised device.

The Occupational Safety and Health Administration (OSHA) also follows this approach. There are 163 entries on the list of KN95s the FDA has authorized for use, while there is a growing list (now standing at 53) of those no longer authorized for use. Both lists can be found at this link, which members also should bookmark and check frequently. Fortunately, we have begun to see a more steady supply of N95s in the market, reducing the need to use the substitute.