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September 28, 2020


Congress Provides Relief on Accelerated/Advanced Payments. The continuing resolution to fund the federal government through December 11, 2020, includes language (see section 2501, page 64) that would give significant relief to Part A providers who received accelerated and advanced Medicare payments earlier in the pandemic. Under existing law, these amounts already would be subject to recoupment from current Medicare payments, but anticipating legislative action, the Centers for Medicare and Medicaid Services (CMS) did not direct Medicare Administrative Contractors to begin recouping. The continuing resolution passed the House of Representatives last week and currently is pending in the Senate. We anticipate the measure will be passed and signed by President Donald Trump before the Wednesday deadline without any difficulties. The language allows Part A providers to request to have recoupment deferred for one year after they received the accelerated/advanced payments and then to delay full repayment for another 17 months, for a total of 29 months after receiving the funds. For the first 11 months of the repayment period, only 25% of the total may be recouped. The continuing resolution also lowers the interest rate under the program to 4%.

SNF Testing Survey Monkey Finally Arrives. The Health Department (ODH) posted the following notice to the Enhanced Information Dissemination and Collection System (EIDC) this afternoon. It naturally includes an extension of the deadline for completing the Survey Monkey. This is a one-time, opt-in/opt-out survey for state testing support.

Please complete this mandatory online survey by Wednesday, September 30 at 9 AM. Your responses to this survey are necessary to help the state prepare to support nursing home testing per the CMS and state testing requirements. This survey will give us POINT IN TIME information regarding nursing homes' needs for state support for testing. This survey should be completed one time by each nursing home.

Survey link: https://www.surveymonkey.com/r/OHNFTestingSupport

A different survey link will be distributed at a later date for nursing homes to provide updated information on an ongoing basis regarding their needs [for] state support (i.e. to opt in/out, update supply requests, update point of contact information).

ECHO National Nursing Home COVID-19 Action Network Kick-Off Webinar. On Thursday, October 1, from 1:30 to 3:00 p.m., the Centers for Disease Control and Prevention (CDC) will hold a webinar that they describe as follows: "Learn about free training and mentorship available to nursing homes across the country to increase the implementation of evidenced-based safety practices to protect residents and staff." This would appear to be the beginning of the long-awaited Project ECHO that reportedly is tied to $6,000 stipends for participating SNFs. Speakers include Dr. Nimalie Stone of CDC and Dr. Richard Feifer of Genesis HealthCare. Questions and answers will be included. You may register for this webinar here.

Reminder: Additional MDS Data Items Take Effect October 1. On Thursday, the additional data items the Department of Medicaid (ODM) added to OBRA assessments will become mandatory. ODM posted a brief page of instructions relating to these items.

NHSN CLIA Reporting Pathway. According to a recent article by Alliant Health, and also as reported by AHCA, the National Healthcare Safety Network (NHSN) will implement a new pathway in their COVID-19 module by which long-term care providers can satisfy their Clinical Laboratory Improvement Amendments (CLIA) reporting obligations for point-of-care antigen testing. This new pathway is to be available October 15. Because the expanded, line-level CLIA reporting requirements will include patient-identifying information, providers who intend to report through the NHSN pathway will need to upgrade their Secure Access Management Service (SAMS) access from Level 1 to Level 3. It is our understanding that this process takes at least 4 weeks, so you may wish to begin now. This NHSN page describes how to upgrade your SAMS access. Please note that per AHCA, the NHSN pathway is an alternative means of meeting the CLIA reporting requirements and is not mandatory. Providers may opt to report to ODH's laboratory program instead.

CMS Quick-Start CLIA Certification Guide. CMS announced a new tool to help laboratories apply for CLIA certificates (including facilities applying for Certificates of Waiver) for COVID-19 testing more quickly and easily. According to the announcement, "CMS’s quick-start guide helps laboratories with the application process for CLIA certification and includes information on the expedited review process implemented at the beginning of the public health emergency that allows labs to start COVID-19 testing before the official paper certificate arrives by postal mail."

Bureau of Infectious Disease Interpretations. OHCA recently asked two questions of ODH's Bureau of Infectious Disease (BID) that they answered today. The following are verbatim from BID's Amanda Smith, except for the headers.

  • Previously positive residents. Thank you for your question about isolation and TBPs [transmission-based precautions] for nursing home residents who have recovered from COVID-19 during the last 90 days and return to the NH after a hospitalization.

Since there insufficient evidence to date that suggests SARS-CoV-2 reinfection can occur in nursing home residents, a resident recovered from COVID-19 who is readmitted back into a nursing home during the 90 days following a positive COVID-19 test does not require a period of isolation during those 90 days. After this initial period has transpired, these residents can be managed similar to residents who haven’t previously tested positive for COVID-19. As we learn more about COVID-19 reinfection, CDC guidance will be updated to reflect known best practices.

Additional information on new admissions or readmissions to nursing homes can be found here under the subtitle “Considerations for new admissions or readmissions to the facility”. Information on what is known about COVID-19 reinfection can be found here and here.  

  • Trips into the community. Thank you for contacting the Ohio Department of Health. I reached out to the Centers for Disease Control and Prevention (CDC) regarding your question and the following is their reply. 

CDC’s Guidance for ALFs (Considerations for Preventing Spread of COVID-19 in Assisted Living Facilities) guides ALFs to check with state and local officials when making decisions about relaxing restrictions. CMS has created Nursing Home Reopening Recommendations for State and Local Officials and recently released guidance on Nursing Home Visitation. Although these guidance documents were created specifically for nursing homes, the content might also be informative for ALFs. In some jurisdictions, a total restriction of visitors or resident’s ability to leave/re-enter the facility might be warranted based on community prevalence, case status in the nursing home, and facility factors (staffing levels, testing access, PPE, local hospital capacity). Some CMS considerations for resident trips outside the facility include: the resident must wear a mask, and the facility must share the resident’s COVID-19 status with the transportation service and entity with whom the resident has the appointment (if leaving for a medical appointment). Residents should be screened when re-entering the facility (temperature check, ensure face covering/facemask, questionnaire about symptoms and potential exposure, and observation of any signs or symptoms) and practice source control within the facility. These considerations apply for all reopening phases (phase 1, 2, and 3).

CDC guidance for LTCFs does not have specific recommendations for residents who go into the community for non-medical reasons. However, recommendations for those who go off-site for hemodialysis, chemotherapy, or other medical reasons may be informative. CDC does not recommend that LTCF residents who go off-site for hemodialysis be kept in observation or quarantine, in part because the observation period would be permanent since these residents leave the facility 3 times per week. The potential benefit of placing residents into quarantine or observation to reduce risk for COVID-19 introduction must be weighed with the disruptions from extended isolation and the removal from their usual living arrangement. Specifically in the ALF setting, the resident is very likely to have their own separate room or apartment, although may share with a roommate or partner, so they may already have some level of separation from other residents and staff that is not present in the nursing home setting. Additionally, LTCF residents who leave and return for dialysis should not be considered new admissions or re-admissions to be housed in a COVID-19 care or observation unit when they return to the facility. Placing them in the observation or COVID area within the facility could put them at higher risk of exposure to COVID-19.

Facilities should consider not housing residents that are leaving the facility frequently with an individual whom they may be putting at higher risk of exposure to COVID-19. Minimizing or restricting movement between AL residents who are leaving the facility frequently and the nursing home residents should be considered. For ALFs, especially for residents leaving the facility and going out into the community, policies regarding wearing a mask both outside of their room while in the facility, but also when outside of the building, and requiring temperature and symptoms screening upon entry into the building (similar to staff) are some suggestions that may work well in this setting. Social distancing measures should be implemented, such as minimizing movement of these residents within the facility as much as possible, and encouraging residents to practice social distancing while outside the facility. Residents should also be encouraged to monitor for symptoms and immediately report fever or other symptoms consistent with COVID-19.

Office Hours: Department of Labor and COVID-19 (from AHCA/NCAL). On Wednesday, September 30 at 3:00 PM Eastern, AHCA/NCAL will host an “office hour" to answer your questions about the new Department of Labor coronavirus leave requirements. Our Department of Labor (DOL) consultants from Jackson Lewis, Craig S. Roberts , Principal and Henry  Shapiro, Associate, will present an overview and updates to leave requirements in the Families First Coronavirus Response Act impacting long term care. This overview will include the new definition of healthcare workers. After their presentation, the consultants will be available for your questions. Please note, this is not meant to take the place of guidance from your legal counsel. 

No pre-registration is required but you will need to login using your computer or WebEx app as questions will be accepted using the chat function. All lines will be muted.  

Join the WebEX h ere

  • Meeting number (access code): 172 101 3462 
  • Meeting password: Pb3V8xmJJW2
Considerations When Testing Residents and Employees and Screening Employees for COVID-19 (from AHCA/NCAL). With test kits being distributed to SNF and ALs, there are several considerations to take into account around screening employees and testing both employees and residents for COVID-19.
The Society for Human Resource Management (SHRM) recommends employees be screened privately. Medical information, including an employee’s temperature and answers to screening questions will need to be maintained as a private medical record.  

Time spent waiting for the health screening and testing should be recorded as time worked for non-exempt employees.  

The U.S. Equal Employment Opportunity Commission (EEOC) reminds employers that typically, measuring an employee’s body temperature is a medical examination. Employers may measure employees’ body temperature because the CDC and state/local health authorities have acknowledged community spread of COVID-19 and issued precautions.  

Applying the Americans with Disabilities Act (ADA) standard to the COVID-19 pandemic, employers may take screening steps to determine if employees entering the workforce have COVID-19 because an individual with the virus will pose a direct threat to the health of others. Testing administered by employers consistent with the current CDC guidance will mee the ADA’s “business necessity” standard. This would apply to SNF, AL, and IDD providers.  

An employer may not require an antibody test before permitting employees to re-enter the workplace. The antibody test, at this time does not meet the ADA’s “job-related and consistent with business necessity” standard for medical examinations. This does not apply to the diagnostic tests mentioned above.  

For staff conducting COVID-19 testing, the Occupational Safety and Health Administration (OSHA) categorizes workers who collect/handle specimens from potentially infectious patients as very high occupation exposure risk. This is the highest risk category for occupation risk for COVID-19.  

It is important that staff conducting COVID-19 tests and/or handling specimens are utilizing the appropriate PPE per OSHA and CDC guidance.  

Additional answers to frequently asked questions around the ADA, Rehabilitation Act, and other EEO Laws can be found on the EEOC’s website

Work-related employee COVID-19 cases are recordable illnesses on the OSHA 300 Logs. Additional information and guidance is available here.