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June 13, 2020

Further direction on NHSN reporting. Over the last few days, AHCA has been in communication with the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) about the civil money penalties (CMPs) CMS imposed earlier in the week on SNFs that allegedly didn't comply with the requirement to report COVID-19 data to the National Healthcare Safety Network (NHSN). Please see this AHCA blog post for detailed direction from NHSN on how to address a number of the most common issues with provider reporting that led to CMPs. AHCA also reiterates that, "CMS has stated that they intend to be fair on reviewing IDRs for citations and CMPs issued as part of this regulation as long as providers can show that they did submit the data or have been trying to register or submit the data but had delays in resolving challenges because of CDC’s help line being overwhelmed with requests."

Testing volunteers? Marisa Weisel of the Department of Medicaid (ODM) notified us that the state is looking for volunteers from Zone 2 (central and southeast Ohio) for testing in the National Guard program next week. If you would like to volunteer, please email

ODM allows NPs, PAs signature authority for the HH POC. On Thursday, Governor Mike DeWine issued an executive order that authorized ODM to adopt emergency rules. These rules took effect yesterday. Many of the changes relate to emergency provisions already in place, such as telehealth flexibilities and waiver of signature requirements, but one of them is a new amendment to rule 5160-12-08 on registered nurse assessment and consultation services. This amendment authorizes advance practice nurses (NPs) and physician assistants (PAs) to sign plans of care under the Ohio Home Care program. CMS implemented a similar waiver for Medicare beneficiaries several months ago. The new emergency rule aligns home health for Medicaid beneficiaries with the federal policy. The Ohio waivers are temporary and are set to expire in 90 days. OHCA will continue to review the emergency rules for additional flexibilities.

CMS clarifies hospice discharge statement from recent guidance. This week, CMS released updated COVID-19 frequently asked questions (FAQs) for non-long-term care facilities. The update includes material on hospice care that revises CMS's previously-published guidance in Quality, Safety, and Oversight letter 20-16-Hospice. Most notable is an answer to a question about hospice staff efforts to serve patients in assisted living communities. The new FAQ revises the previous guidance to read:

If after reasonable attempts have been made and documented in the patient’s record and the hospice continues to be unable to access the patient in-person, the hospice would have to discharge the patient as "outside of the hospice’s service area."

OHCA submitted this response to NAHC for further clarification, as it conflicts with previous FAQ guidance permitting telehealth visits to continue hospice care benefits if feasible and appropriate. CMS responded to the NAHC inquiry: “[i]f the hospice is able to utilize telecommunications to address the patients needs that would be appropriate.” There is no response yet on how long a hospice can go without face-to-face interaction.

Eleven HCICs approved. ODM informed us yesterday that it approved eleven Health Care Isolation Centers (HCICs). Please follow this link to view the list of approved centers and their retroactive effective dates. The Department of Health (ODH) approved these applicants some time ago, but ODM waited to give their blessing for reimbursement purposes until they completed an emergency rule establishing the rates and requirements for HCICs. The rule now has been filed. It is still possible for additional providers to apply for HCIC designation.

Interpretations of requirements and guidelines. During this week's virtual meeting with ODH, staff from the Bureau of Infectious Diseases (BID) confirmed that masks are recommended for residents when outside their rooms and during hands-on care. This recommendation takes into account the resident's tolerance, and the BID personnel recognized masks may be difficult for residents with dementia or other cognitive or behavioral conditions. They also agreed that the recommendation is to quarantine for 14 days all new admissions, readmissions, and residents with known exposure to COVID-19. Facility policy can go beyond this to include quarantining for trips into the community, but the provider should evaluate the degree of exposure risk the resident experienced when making this decision. BID staff also confirmed that group activities and dining can occur with proper distancing. We asked about the applicability of the Director of Health order prohibiting groups of more than 10 as well as whether roommates and others who otherwise regularly interact could be in closer proximity for dining and activities. They said they would get back to us on those points. Providers should contnue to discourage outside appointments that can be postponed or rescheduled, such as annual dental and eye examinations. This principle does not apply to urgent matters.

On another issue, we heard from members that certain companies that do inspections and maintenance indicated that their services are essential and they should be allowed into buildings. We contacted Chief Alan Smith of the Fire Marshal’s Office, who said unless there is an emergent issue such as a sprinkler system out of service, general inspections and maintenance that have been waived should not be done, to mitigate the risk of exposure to residents. If you have other examples and would like OHCA to follow up, please send them to Mandy Smith, Regulatory Director, at

CMS issues warning on SNFs taking stimulus checks. This week, CMS published a notice to SNFs warning them not to "seize" residents' Economic Impact Payments (EIPs), also known as stimulus checks. We understand there also has been Congressional pressure on this issue. The notice, while inflammatory in its language, provides an important reminder that EIPs should not be applied to past due balances without the patient's consent and are for their personal use. The notice acknowledges that CMS has received no specific complaints about this practice, but we wanted to make members aware of the notice, as it instructs family members and residents to contact their Attorney General or State Survey Agency if they feel their EIP was handled improperly.