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September 8, 2020

County Positivity Rates for SNF Staff Testing Change Again. For the second time in five days, the Centers for Medicare and Medicaid Services (CMS) posted new county-level positivity ratings that control how often SNFs must conduct routine staff testing. Please see the new Ohio-specific table. The new table is effective now. If a county's color increased (e.g., yellow to red), the higher testing frequency applies immediately. If it decreased (e.g., red to yellow), SNFs in the county must continue to test at the previous frequency for 14 more days.

CMS National SNF Call. On the CMS national call for SNFs this evening, featuring CMS Administrator Seema Verma, Department of Health and Human Services (HHS) Assistant Secretary for Health Admiral Brett Giroir, Centers for Disease Control and Prevention Director Robert Redfield, and other federal officials, the main focus naturally was on the mandatory SNF testing requirements. CMS posted slides from the call, but much of the material presented was not included in the slides, and what is in the slides was brushed over lightly. Most of the session was devoted to Administrator Verma, Admiral Giroir, and Director Redfield explaining their latest actions relating to SNFs. There was some new information:
  • Administrator Verma commented that the recently released national training program is valuable to assisted living communities and other congregate settings, as well as SNFs.
  • Admiral Giroir reported that HHS has shipped 13,477 antigen point-of-care (POC) testing units to 13,343 SNFs, along with 4.7 million tests. He said shipments would go to the other 507 SNFs this week. He added that testing supplies would be available for the BD units next week and mentioned there are 6 distributors (previously we understood there to be two). Admiral Giroir said it is a violation of federal law for states not to permit use of the antigen machines.
  • Admiral Giroir said next week HHS plans to begin distributing 750,000 Abbott BinaxNOW cards to SNFs in red and yellow counties across the country. He did not mention assisted living or other recipients, but did say states would receive shipments for school openings or other uses. The shipments to SNFs will continue until the 150 million cards are distributed. Admiral Giroir said SNFs must have a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver to use the cards, like the POC testing devices. To increase throughput, he advocated "daisy-chaining" the tests and purchasing additional units.
  • Dr. Redfield said admitting a patient already diagnosed with COVID-19 is not considered to result in an outbreak, but if the patient is not diagnosed until after admission, it is an outbreak.
  • Responding to questions, the federal officials defended testing contractors, broadly defined, per the facility frequency, testing everyone in the event of an outbreak, and their method of assigning county testing frequencies.
  • Administrator Verma and others repeatedly noted they are allowing for enforcement discretion, both in compliance with the testing mandate and the CLIA reporting requirements, but the provider must document their efforts to comply.

Complaint Visits, RCF Annuals Restart. The Health Department's (ODH's) Rebecca Sandholdt reported today that ODH began to conduct complaint visits for 10-day complaints that backed up since March and also started to do annual surveys for residential care facilities (RCFs - assisted living). Previously, only two-day complaints (immediate jeopardy) and Focused Infection Control surveys were done. Ms. Sandholdt said all of these surveys would primarily be conducted remotely, but would include on-site time by a limited number of surveyors to make observations. Because of the backlog of complaints, all complaints against a specific facility will be bundled and investigated at once, which could result in complaint visits lasting multiple days. One OHCA member reported that theirs is to be two weeks long.

Ms. Sandholdt gave no timetable for resuming annual surveys of federally regulated long-term care and non-long-term care providers. She continues to insist that ODH will not do annuals without changes in the survey process to improve safety like those noted above relative to complaints. RCF annuals are re-starting in modified fashion because ODH controls how those surveys are done. ODH also plans to conduct COVID-19 tests within the next few days on all surveyors and other staff who could go into buildings.

CMS Updates for ICFs/IIDToday, OHCA participated in a call with CMS staff to discuss ICFs/IID.   CMS’s Don Howard kicked the call off by speaking about the restart of annual certification surveys for ICFs.  Mr. Howard stated that it looks like surveys across the nation are slowly restarting. OHCA asked if CMS intends to make any modifications to the ICF survey process given that it is largely based on observation. Mr. Howard responded that they are giving State Survey Agencies flexibility to limit exposure in facilities by allowing documentation review and phone interviews, but anticipate surveyors will follow up in person if any concerns are identified. As discussed above, ODH’s Ms. Sandholdt said she still is awaiting CMS approval of annual survey survey process changes, but ODH already re-started complaint surveys. Mr. Howard mentioned that CMS is seeing an increase in citations for survey tag W455, which reads, “[t]here must be an active program for the prevention, control, and investigation of infection and communicable diseases.” W455 is now in the top 10 most-cited tags for 2020. ICF providers should review the relevant State Operations Manual provisions to ensure compliance with all of the infection control and prevention tags (W454, W455, W456, W457, and W458). 

AHCA SNF VBP Webinar. AHCA held a webinar this morning to explain what they know about the HHS value-based purchasing program for SNFs, funded with $2 billion from the Provider Relief Fund. This program is already underway. It offers SNFs four separate, monthly opportunities to earn incentive payments for having lower COVID-19 case numbers and mortality than their peers in similar counties across the country. The specific criteria to qualify for funding and the specific amounts of the payments are as yet unknown, but AHCA believes that providers from counties with high levels of community spread can qualify for significantly higher payments than those in counties with low amounts of COVID-19. AHCA also offered suggestions for keeping COVID-19 out and reducing spread if it does enter. A recording of the webinar is available on the AHCA website, and the slides can be downloaded from the same link (handouts tab).

CMS QRP COVID-19 Public Reporting Tip Sheets. Today, the CMS post-acute care Quality Reporting Programs (QRPs) released tip sheets for SNF, home health, and hospice providers. The tip sheets explain the agency's strategy to account for CMS quality data that were exempted from public reporting because of COVID-19 and the impact of these exemptions on CMS Compare website refreshes, as well as on provider previews and other reports. Ohio SNF providers should note that items from these datasets are used for the Department of Medicaid quality incentive payments, both old and new. For the current fiscal year, running through June 30, 2021, the data are not affected by CMS's actions because they are for calendar year 2019. To the extent the quality incentive payments are continued beyond this fiscal year - which has not been determined yet - adjustments will be required to address CMS's decision not to report the calendar year 2020 data. 

Aging Offers Webinar on Re-Opening Adult Day Services for Seniors. The Department of Aging will hold the webinar on Friday, September 11, from 9:00-10:30 a.m. The order and guidelines allowing re-opening will take effect September 21. To register for the webinar, please use this link.