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June 23, 2020


State testing webinar. Today's state webinar on the SNF testing program and related topics trod mostly familiar ground, but a few revelations are worth reporting.

  • The Department of Medicaid's (ODM's) Julie Evers provided some additional detail about the $25 million infection control incentive program. She said ODM abandoned the notion of using the infection control self-assessment, obviating the common question of how providers should attest completion of the assessment. Instead, the funding will be awarded solely on results of the Focused Infection Control (FIC) surveys the Department of Health (ODH) will complete this week. Providers with no deficiencies on the FIC survey above D level will qualify; those with E or F-level deficiencies can qualify if they have a clean revisit. According to ODH's Rebecca Sandholdt, of 858 FICs tallied, only 32 deficiencies above D were cited, and only 2 above F. Ms. Evers added that payments will be based on April 2020 Medicaid days, including managed care, and will be made "later this summer." The payments likely will be grants involving an application and a grant agreement.
  • Ms. Sandholdt said ODH's plan for restarting annual surveys will focus on facilities that are outside the 15.9 month window and have a history of G-level or higher deficiencies. Other priorities will be complaints alleging immediate jeopardy (IJ) or actual harm, revisits for IJ cites, FIC surveys, and initial certification surveys.
  • ODH now has portal for lab the requisitions for COVID-19 testing that must be filled out for each employee before the National Guard arrives. If a commercial lab is assigned to a provider, their individual portal is to be used instead of the ODH portal. Here is a view of ODH's form from the portal. Providers cannot complete it until a few days before the scheduled testing date.
  • ODH's Heather Coglianese emphasized, with respect to employees who refuse testing, the facility's obligation to ensure infection control and to limit communicable disease under the SNF licensure rules. These rules and the rule on medical directors supervising employee health are enforceable by survey. She also said ODH will revise the testing guidelines to specify how long after employment new hires must be tested.
  • Marisa Weisel of ODM said if the medical director who issues a testing order is not the employee's usual source of care, the medical director should provide a "warm handoff" of test results to the usual source of care, if any.
  • Medicaid Director Maureen Corcoran said the state would conduct another three-day personal protective equipment (PPE) survey this week, to be announced by the Enhanced Information Dissemination and Collection (EIDC) system. This is connected to the "virtual stockpile" of PPE being developed by hospitals.

Another webinar announced. Through EIDC, ODH announced another webinar on testing. The notice reads:

The Congregate Care Unified Response Team is hosting a webinar tomorrow to discuss specific facility testing in nursing homes. This webinar applies to facilities that have not yet had testing within their facilities. This includes scheduled nursing homes for next week as well as facilities that will be scheduled in the coming weeks. These webinars will be conducted weekly moving forward in case you're unable to attend tomorrow.

Please register for State/ONG-Supported Nursing Home Testing Logistics on Jun 24, 2020 2:00 PM EDT at: https://attendee.gotowebinar.com/register/5866169819881286669. After registering, you will receive a confirmation email containing information about joining the webinar.

Governor hints at re-opening SNFs. In his press conference today, Governor Mike DeWine said he expects to divulge a plan for resuming visitation in SNFs within the next week. He added that great care will be taken in developing guidelines for re-opening. OHCA has worked with Aging Director Ursel McElroy on guidance for re-opening both SNFs and adult day services and also with Developmental Disabilities Director Jeff Davis on expanding access to adult day programs for people with intellectual and developmental disabilities.

Latest from DODD. On several recent occasions, we pointed out the restrictions on handling individuals' Economic Incentive Payments (stimulus checks), particularly relative to SNFs. Now the Department of Developmental Disabilities (DODD) has weighed in with a similar warning, referring to an Internal Revenue Service alert on the topic. DODD also issued a memo explaining that the (virtual) pre-admission counseling process now is live for 8-bed ICFs. The department announced a new Foundations for Success program, "The Future of Meaningful Adult Day Support," to be offered on July 14 from 10:00 a.m. to noon and on July 16 from 4:30-6:30 p.m.

Webcast for PRF Medicaid Targeted Distribution. Today the Health Resources and Services Administration (HRSA) held the first of two webcasts on the Provider Relief Fund (PRF) Medicaid Targeted Distribution (MTD). HRSA and United Health Group staff provided an overview of provider eligibility and how to submit an application using the United Health Group provider portal. Most of the items covered appear in the MTD instructions, the PRF frequently-asked questions (FAQ) page, and the MTD application form. The webcast, however, stressed several points:

General Questions:

  • The curated list of eligible Medicaid providers comes from the state Medicaid office.
  • Providers who received payments to the tax identification number (TIN) used in the General Distribution are not eligible for the MTD. Providers who previously only received targeted distributions, such as the SNF Targeted Distribution, are eligible. Future PRF distributions may not follow the same exclusions.

Payment Questions: 

  • To ensure quickest receipt of payment, providers should check that the information they enter matches the information on their income tax returns exactly, including provider name and address. 
  • Payments will be issued on a rolling basis, with all distributions targeted for disbursement by the end of August.
  • You do not need a contract with United Health Group to receive the funds electronically. You also have the option to receive the funds by check. 

Application Process:

  • If you do not receive an access code by email for your secure application form, check your firewall and spam filters.
  • Corrections to the application can be made by resubmitting it before it is approved or by calling 866-569-3522. 
  • Providers who qualify for a MTD payment will receive notification by email. The portal will not update until the payment is made.
  • The provider attestation will open in the portal once payment is issued.

HRSA indicated that questions not answered during the call will be addressed in future updates to the FAQ. Providers can register here for the second webinar, scheduled for June 25, 2020, at 2:00 p.m.

Latest HHS PRF FAQs. Speaking of the PRF FAQ, the Department of Health and Human Services (HHS) continues to update it on a regular basis, including yesterday. HHS on page 9 added an answer further clarifying that providers have until the end of the pandemic to incur increased costs and reduced revenue that can be covered by PRF payments and another addressing sales of provider entities after they receive PRF distributions. Unfortunately, among a number of questions and answers posted last Friday, HHS doubled down on its position, noted above, that if a provider was eligible to receive any money from the General Distribution, even if it did not retain the money, the provider is ineligible for the MTD (see page 38). HHS did add, "[p]roviders that are not eligible for this distribution may be eligible for future allocations of the Provider Relief Fund."

Additional ODM emergency rule changes affecting hospice. In addition to the rule changes we reported last week, ODM revised several other rules for hospice programs on a temporary, emergency basis. OAC 5160-56-02 was amended to allow certification of terminal illness via telehealth. A change to OAC 5160-56-04 allows hospices to use pseudo-patients for competency testing and to allow individuals who are competency tested only in the tasks for which they will be assigned to function as hospice aides. OAC 5160-56-05 now allows core and non-core services to be provided through a combination of contracting services and telehealth services as necessary. Finally, ODM changed OAC 5160-56-06 to allow telehealth services when in-person visits normally are required. Providers are to add the GT modifier on hospice claims for any component of services delivered via telehealth. Please note that these emergency rules are only effective for 120 days.

Other new material from ODM. Julie Davis of ODM shared two items this afternoon. One is the eagerly-awaited billing guidance for Health Care Isolation Centers (HCICs). Ms. Davis said this material was sent to the now 12 approved HCICs. She also addressed a question on the emergency bed-hold changes:

Additionally, in response to a bed-hold question submitted by OHCA, if a resident is needing bed-hold days in excess of the previous 30-day limit due to COVID, the NF should update the bed-hold notice for the resident so they know the number of bed-hold days used as compared to the revised 60-day limit. Nothing additional will be needed when billing the extra bed-hold days, but the NF is encouraged to maintain any related documentation to support the billing of bed-hold days in excess of the previous 30-day limit.

Non-COVID-related, but of interest: responding to a question from an OHCA member about the renovation exception to the July 1 occupancy threshold for July 1 SNF rates, ODM's Terry Moore said, "ODM is in the process of developing a memo which will delineate the information needed to substantiate the renovation." This exception was defined by House Bill 481, which the Governor signed only last Friday, but the July 1 rates need to be completed soon. The memo hopefully will come out very quickly.

Webcast on PPE strategies. On Thursday, June 25, from 4:00–5:00 p.m., the Centers for Medicare and Medicaid Services and the Quality Improvement Organizations (QIOs) will continue their National Nursing Home Training Series with this week’s webcast on "PPE Strategies for COVID Care." The webcast will explain why using PPE is necessary for infection prevention and will describe how to use it properly. Additionally, participants will learn how to use an audit tool, which will be shared, for tracking compliance in proper PPE use. Promising practices and strategies for PPE supply and use also will be covered. Advance registration is required by clicking here. Providers also can sign up to receive information about the weekly trainings and can view past recordings

FDA warning on hand sanitizers. The Food and Drug Administration issued a warning that certain hand sanitizers should not be used. They contain methanol (wood alcohol), which can be toxic when absorbed through the skin. The hand sanitizers are listed on the warning and all are manufactured by Eskbiochem SA de CV in Mexico. These sanitizers could have been purchased by your company or by your patients or families. To date, the company has refused to remove the product from the market. If you find any of the listed brands, the product needs to be destroyed and should not be flushed down a toilet or poured down a drain.