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September 3, 2020


Assisted Living Providers: Do Not Miss September 13 Deadline. No, the Department of Health and Human Services (HHS) did not give private-pay assisted living providers much time to apply for a federal Coronavirus Aid, Relief, and Economic Security (CARES) Act grant equal to 2% of their 2019 resident care revenue. Nonetheless, an application is required to qualify for this funding, and it is critical not to miss the deadline. Although HHS extended it previously for Medicaid applicants, NCAL informs us that HHS will not extend it beyond September 13. This is the first federal funding for private-pay assisted living communities (aside from CARES Act dollars routed through the state Coronavirus Relief Fund), so don't miss it. All you have to do to meet the deadline is to enter your Tax/Employer Identification Number into the application portal. The rest of the application process can be completed afterward.

CMS Updates COVID-19 County Positivity for SNF Testing. Less than a week after posting the initial county-level COVID-19 positivity percentages, the Centers for Medicare and Medicaid Services (CMS) released an updated version of the table. Click here to see the Ohio counties. Please check the table, as a number of counties changed colors. The new table is dated September 2, the effective date of the CMS testing requirement, so Ohio SNFs should use these positivity rankings, not the previous ones, to plan for the early stages of federally-mandated testing. Unfortunately, providers may have begun preparing with the original positivity percentages in mind, as it was not clear when they would change. Also please remember that despite the advent of CMS's testing rule, the state-mandated, every-two-week testing also remains in place (see article below on the new schedule). OHCA today began discussions with state officials about the future of state testing, advocating that it should be eliminated because of misalignment between the two programs and resulting confusion and burden on members, but no decision has been made.

Trying to Unpack the County Positivity Ratings. OHCA reached out to the Department of Health (ODH) to try to learn how CMS derived the county positivity ratings that support the new COVID-19 routine testing requirements for SNF staff. After we discovered that ODH does not have a mechanism in place to collect line-level, county-specific data for all COVID-19 tests performed on Ohio residents by all laboratories, we questioned how CMS derived their county positivity ratings. According to ODH, the 6 big commercial reference laboratories serving Ohio (LabCorp, Quest, Mayo, BioReference, Sonic, and ARUP), along with the state public health lab, report data to HHS and the Federal Emergency Management Agency (FEMA) at the line level, meaning they report both positive tests and negative tests with demographic information on where the individual lives. ODH believes those data account for approximately 80% of the tests conducted in Ohio and are the basis of the current county positivity scores.

ODH is working enhance the data in two ways. First, approximately 52 hospital labs are reporting only aggregate data, which means a hospital like the Cleveland Clinic, where specimens are pulled from a 21-county catchment area, has all their tests attributed to Cuyahoga County. Second, there appears to be no cutoff for something called "unstable rates," meaning counties in which so few tests are conducted that a small number of positives changes the percentage significantly. This is why Ohio is moving to line-level reporting of both positive and negative results by all labs serving Ohio, including labs with a Clinical Laboratories Improvement Amendments (CLIA) Certificates of Waiver (e.g., SNFs using point-of-care testing units). OHCA will continue to monitor this situation and to encourage a solution that will make it as easy as possible for SNFs to report line-level data. 

State Announces Next Week's SNF Testing Schedule. In an Enhanced Information Dissemination and Collection (EIDC) System notice, ODH published the state-supported testing schedule for next week. Please note that this schedule does not apply to or govern CMS-mandated testing. SNFs must schedule and complete that testing on their own, although in many cases, the state-supported testing can do double duty. For instance, if a SNF is in a yellow county on the CMS list, it must test weekly. If the SNF is scheduled for state-supported testing before next Wednesday (a week after the effective date), it also could count as the first weekly CMS test. If it is scheduled for state testing later in the week, it could count as the second test, but the SNF would have to complete the first test by Wednesday. If the SNF is subject to outbreak testing, the state-supported testing could suffice as one of the required tests for staff, depending on the timing, but the SNF would have to arrange its own testing for patients.

Because no swabbing or specimen pick-up is taking place on Labor Day, there are some anomalies to next week's schedule. As the notice explains:

PLEASE CHECK ALL DATES AND LAB ASSIGNMENTS CAREFULLY

- All facilities that collected specimens 14 days prior to 9/7 (Labor Day) were assigned to an alternate dates for specimen collection/swabbing and pick-up in this schedule. These       facilities are highlighted in blue on the schedule (column D)

- Please carefully review the schedule for your facility's dates and lab assignments.

- Facilities with new lab assignments have "yes" listed in column G

- Facilities that changed labs but already filled out some or all forms: Please email CCURT with the number of requisitions you have already completed so we can "move" them to the correct lab behind the scenes. Please include your facility name and license number (if licensed) in the email.

OPTION FOR RESCHEDULED FACILITIES – ONLY FOR FACILITIES HIGHLIGHTED IN BLUE ON THE SCHEDULE

- Instead of using the dates assigned in the schedule, you may swab all staff and take specimens to your assigned lab on Tuesday (9/8). This is not required, but is being offered as an option.

- If you plan to use this option, you must drop off specimens at your assigned lab by 5 PM on Tuesday 9/8, and all specimens must be collected within 24 hours prior to dropping at the lab.

       - If your assigned lab is Mako, you can ship specimens back to Mako by Wednesday 9/9 at 8 AM (ideally you will ship out via FedEx on Tuesday instead of the following morning)

- If you plan to use this option, you MUST email the CCURT inbox by 9 AM on Monday, 9/7, to let us know that you will be using this option. Your email should include:

       - Name of your facility

       - ODH license number (if licensed)

       - A statement verifying you will take your specimens to your assigned lab by 5 PM on 9/8 (or ship to Mako by 8 AM on 9/9) and you understand the ONG will not pick-up specimens from your facility later in the week.

- You can proceed with this option ONLY after receiving a reply from CCURT saying we have received your alternative plan. The response will include drop-off instructions.

What To Do If You Cannot Obtain Timely Testing for SNF Staff. In the guidelines for the federally-mandated SNF testing program that took effect yesterday, CMS conditioned the weekly (yellow county) and twice-weekly (red county) testing frequencies on availability of testing capacity that can deliver results within 48 hours. The guidelines, however, do not specify what a SNF is to do if they find themselves in that situation, other than to reach out to state and local health officials for assistance. If that proves unavailing, arguably the facility has no federal testing requirement, as untimely test results are of no value in preventing virus spread. AHCA's Dr. David Gifford recommends that the center email the State Survey Agency (ODH) about its quest for 48-hour turn-around, including the following:

  • A list of the laboratories it contacted and the responses.
  • An explanation of its interactions with the local health department.
  • A statement that because of its lack of success in obtaining the necessary turn-around, it is not doing the CMS testing.
  • A description of its plan for continuing to search for a suitable laboratory. (See AHCA's curated list of lab options for ideas.)
  • A respectful request that if the Survey Agency can help or has any concerns with the center's approach, it should respond immediately.
Please note that this suggestion does not apply to Ohio's state-mandated testing or to outbreak testing, neither of which are conditioned on turn-around time.

HHS Formally Announces SNF VBP Program. HHS posted a notice today on the value-based purchasing (VBP) component of the $5 billion Provider Relief Fund targeted distribution for SNFs. HHS distributed the first $2.5 billion last week on a per-facility basis to cover the cost of testing and other infection control measures. As expected, the VBP component will amount to $2 billion, divided equally into four monthly allotments of $500 million for September, October, November, and December. The money will be distributed to centers that fare well in a monthly comparison of COVID-19 cases and deaths against buildings in similarly situated counties. HHS did not announce the details of the comparison process or the amounts of payments to qualifying facilities. AHCA predicts the first payment could be made by mid-October.