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September 29, 2020

ODH Stands Firm on Eye Protection in SNFs. Members reported that Department of Health (ODH) surveyors required staff to wear eye protection (face shield or goggles) in addition to a facemask when caring for any patient in a SNF in a red, yellow, or purple county under the Ohio Public Health Advisory System, based on their reading of Centers for Disease Control and Prevention (CDC) guidelines. OHCA disagreed with this interpretation and provided an explanation to ODH showing that other, more specific CDC guidelines only require eye protection during care for certain patients, not all patients. In a meeting today, ODH personnel rejected OHCA's argument and continued to insist on eye protection when caring for any patient in a SNF in one of the affected counties. They said they consulted someone with CDC, who agreed with their position. Unless there are further developments, we recommend members comply with this dictate.

New Positivity Rates for SNF Testing. The Centers for Medicare and Medicaid Services (CMS) published new county positivity numbers, dated September 28, for use in determined routine testing frequency for SNFs. This week, Athens County joins Putnam County in the red category, requiring testing of all staff twice a week. Eighteen other counties are graded as yellow. Pike, Stark, Montgomery, and Mercer Counties all are so-called mismatch counties that are green on the CMS list but red in the Ohio Public Health Advisory System, which means Ohio will require SNFs in those counties to test staff weekly. ODH has not yet issued guidelines specifying this requirement and making other modifications in the state testing program that were outlined in last week's webinar.

Project ECHO Update. Over the past several weeks, many OHCA SNF members inquired about the status of Project ECHO, an educational series that is not mandatory but is tied to a certain amount of federal funding. Today, OHCA and other state affiliates of AHCA and LeadingAge met with leadership from the Agency for Healthcare Reasearch and Quality, the federal agency overseeing this initiative, and from Project ECHO and the Institute for Healthcare Improvement to learn about the program. Academic medical centers dubbed hubs will lead 90-minute, collaborative, Zoom-based training sessions for 30-35 SNFs at a time, once a week for 16 weeks. In some areas, these programs could begin as soon as two weeks from now. Three people from each SNF must participate in all of the sessions to earn the $6,000 stipend for the facility. An additional 36 weekly programs will be offered after the initial 16. SNFs may use this link for more information and to sign up for the program. You also may register at this link for a webinar on Thursday, October 1, at 1:30 p.m., that includes an introduction to Project ECHO.

Other ODH Interpretations. In addition to the eye protection issue in the article above, ODH representatives provided a few other regulatory interpretations in the meeting today.

  • Dr. Mary Kay Francis agreed that in the case of a positive antigen test in an asymptomatic individual from a point-of-care machine or a BinaxNOW card, only one negative polymerase chain reaction (PCR) test is needed to override the positive if it is conducted within 48 hours. She said two PCR tests would be required if the first confirmatory test is not done within that period.
  • Jill Shonk agreed that a KN95 respirator can be used, even though an N95 is available, if the situation is not one in which an N95 is required.
  • Rick Hoover clarified that a notation by the Fire Marshal's Office about a temporary wall for a COVID-19 unit is not considered a citation and is not a problem for licensure. While normally such a temporary wall would not be permitted, it is allowed during the Public Health Emergency. The notation is a reminder to the Fire Marshal to follow up after the emergency ends.

Missing PASSPORT Funds in the CRF Report? You’re Not Alone. Today, OHCA learned of an issue with PASSPORT distribution amounts from the Ohio Coronavirus Relief Fund (CRF) for home care agency providers. Per Patrick Beatty, Deputy Director of the Department of Medicaid, “[t]here was a systems issue that prevented the fiscal folks from seeing the PASSPORT claims history needed to trigger the calculation of CRF amounts. They are in the process of addressing that. In the mean time I will be recommending calculating a CRF amount for the PASSPORT component. This may take a couple of weeks.” Providers should carefully review the list of outstanding CRF distributions and their allocated distributions for this possible discrepancy.

Additional Direction on Livanta Notice for Secure Messaging Requirement. Since Livanta issued a notification that federal regulations under Federal Fiscal Year 2021 Final Rule CMS-1735-F now require ALL providers to transmit medical records and other documentation (like the Notices of Non-Coverage) to the Beneficiary and Family Centered Care Quality-Improvement Organizations (BFCC-QIOs) electronically, OHCA received questions from members on how to comply with the requirements.  Beginning October 1, 2020, Livanta only will accept medical records electronically via Direct Secure Messaging. To clarify, secure Direct Secure Messaging is NOT email. Your organization must obtain Direct Secure Messaging credentials that support accredited Health Information Service Provider (HISP) protocols.

Today, OHCA reached out to two major electronic medical record (EMR) vendors for SNFs, PointClickCare and MatrixCare. Both vendors confirmed that their EMRs contain integrated direct secure messaging that complies with this new requirement. For more information on how to access the Direct Sure Messaging feature, or if you utilize a different EMR system, please check with your EMR vendor. Lastly, if you experience problems transmitting medical records to Livanta, you can call (877) 588-1123 for additional assistance.

CMS Issues QSO on Emergency Preparedness Exercise Exemption. CMS released Quality, Safety, and Oversight letter (QSO) 20-41-ALL addressing emergency preparedness exercises. The QSO exempts providers from required full-scale exercises if they activated their emergency procedures because of COVID-19. The QSO lists documentation needed to support the exemption. 

Influenza Vaccination Data Reporting for Long Term Care Facilities (from AHCA/NCAL). With flu season approaching, the Centers for Disease Control and Prevention (CDC) has implemented two new features in the National Healthcare Safety Network (NHSN). Long term care facilities will now be able to track weekly influenza vaccination data beginning with the 2020-2021 influenza season for both healthcare personnel and residents. To provide detailed information about the new tracking information, the CDC will host two webinars on October 1 and October 6. You are encouraged to register in advance for the webinars as spaces are limited. You can learn more about reporting weekly influenza vaccination data here.