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June 10, 2020

What else do we know about the Provider Relief Fund Medicaid Targeted Distribution? The Department of Health and Human Services (HHS) updated its frequently-asked questions (FAQs) on the Provider Relief Fund (PRF) with new information about the Medicaid Targeted Distribution announced yesterday.  Starting on page 32, the FAQs cover questions such as who is eligible (Medicaid providers who received payments under the PRF General Distribution cannot apply for the Targeted Distribution), how the payment will be calculated (2% of gross patient revenue for one of three years), and what documentation must be uploaded to the online application portal. Providers have until July 20, 2020, to submit an application. According to one of the answers in the FAQ, HHS will not wait until all eligible providers have applied to begin making payments: "[p]ayments will be disbursed on a rolling basis, as information is validated. HHS may seek additional information from providers as necessary to complete its review." No specific time period after a provider applies is given for payments to start.

Earlier this evening, HHS opened the portal to apply for these funds.  The HHS site includes instructions for applying and a PDF version of the online form. Before applying, we recommend you first review the FAQs carefully and collect the documentation necessary to submit your application accurately through the portal, as it cannot be corrected once submitted. This is especially important for providers who have multiple tax identification numbers (TINs), to ensure the correct TIN is used in the application.

Other PRF FAQs added. For providers who did receive previous PRF payments, HHS again added more questions and answers to the FAQ that do not deal with the Medicaid Targeted Distribution. These additions can be found by searching the document for "6/8/2020" and "6/9/2020."

NHSN reporting and CMPs. Numerous OHCA members reported that they received civil money penalty (CMP) notices from the Centers for Medicare and Medicaid Services (CMS) for alleged failure to report data on COVID-19 to the National Healthcare Safety Network (NHSN). Some members explained that they tried to register with NHSN but were unable to complete the process and did not get timely assistance from NHSN. In other cases, though, members registered and submitted data, but still received CMP notices. We confirmed with AHCA that these issues are common nationally, and potentially thousands of SNFs were fined erroneously. AHCA also pointed out that some providers may not even be aware of the CMP because CMS posted it to the Certification and Survey Provider Enhanced Reports (CASPER) system instead of sending it directly to the center.

In today's national SNF call, CMS's Evan Shulman confirmed that to contest a CMP, even one that is clearly wrong because the center submitted the data, the provider must file a request for an Independent Informal Dispute Resolution (IIDR) as specified in the CMP notice. Mr. Shulman said CMS intends to be fair and will reverse inappropriate CMPs based on review of documentation submitted by the provider.

AHCA's Dr. David Gifford suggests the following for the IIDR request:

  • If you made a good-faith attempt to register but were stymied by technical issues, you should submit copies of all correspondence with NHSN and a cover memo stating that you attempted to register and listing the attached correspondence by date.
  • If you successfully reported data but still got a CMP, you should submit screenshots of the calendar from the portal with the blue bars showing the dates for which data were submitted.
In the latter case, please send OHCA your screenshots. We will share them with AHCA to support their efforts toward a global solution for providers who actually submitted data. Please do not wait for the global solution, though. Protect yourself by submitting the IIDR.

Changes to reimbursement for day services. The Department of Developmental Disabilities (DODD) released guidance for reimbursement of center-based day services that recognizes the current order limiting day services to settings of 10 people or less is not in line with the department's current reimbursement structure, which is based on higher client ratios than currently allowed. To address this disconnect, DODD created new billing codes that allow providers to bill for adult day and vocational habilitation services at the current reimbursement rates for acuity group C. Providers can bill with the new service codes for dates of service beginning June 1, 2020. In addition, DODD released an updated Risk/Benefit Discussion Guide to help determine if a person should return to day services.

Testinprogram updates. In a call today with Department of Health (ODH) personnel, they shared several points relative to the National Guard testing program.

  • Only Zone 1 (northern Ohio) is included in the first testing "sprint." The centers selected for testing received an email at about 9:30 last night from ODH's James Hodge. Testing will begin next week.
  • Early next week, Zone 2 (central and southeast Ohio) and Zone 3 (southwest Ohio) will begin sprints. Part of Zone 3 will be notified by Dayton Children's Hospital and part of the zone will be notified by the state zone leader, Julie Evers.
  • No further written guidance or frequently-asked questions are available yet. ODH also has not prescribed how a center should handle an employee who refuses to be tested despite the center's best efforts.
  • ODH legal counsel Heather Coglianese asserted that facility medical directors need to provide physician orders for testing per a verbal conversation between Health and the State Medical Board and OAC rule 3701-17-13(A)(5), which requires medical directors to "[m]aintain surveillance of the health of the nursing home's staff." We responded that absent something in writing from the Medical Board, we are not convinced.

ODH's Rebecca Sandholdt said although no other details on the infection control incentive payment program announced last week have been finalized, the self-assessment is the one that is part of CMS Quality, Safety, and Oversight letter 20-20-All.

NCAL PPE survey. NCAL sent the following message today asking members to participate in a survey to support their advocacy efforts for assisted living:

The National Center for Assisted Living (NCAL) is conducting a survey for assisted living (AL) providers only to understand their access to personal protective equipment (PPE). We know members are anxious about supplies. It is critically important the data collected in this survey is accurate and to help understand the availability of PPE for AL providers.

Please complete the survey by Wednesday, June 17. You can find the survey here. Please take about 5-10 minutes to review your supply inventory and determine how soon you may run out of PPE before completing this survey.