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June 29, 2020

Governor announces SNF re-opening July 20. At his press conference today, and notwithstanding a now five-day spike in COVID-19 cases in Ohio, Governor Mike DeWine announced that outdoor visitation will be permitted at SNFs starting July 20. The Governor outlined factors that SNF operators should consider in deciding whether to allow visitation at that time. These factors tie back to the recent Centers for Medicare and Medicaid Services (CMS) guidelines on visitation. The Governor suggested - and we believe this to be true - that the guidance for SNFs will be very similar to that in effect for assisted living and ICFs/IID for the past three weeks, including significant facility flexibility. Unfortunately, however, as of this writing, neither the fourth amended Department of Health order nor the visitation guidance has been published.

Surprise! More PRF FAQs. The Department of Health and Human Services published further updates to its now-44-page frequently-asked questions (FAQ) document, almost all specific to the Medicaid Targeted Distribution (MTD). The following are items particularly affecting OHCA members:

  • Providers who are paid through a Medicaid certified public expenditure (e.g., ID/DD waiver providers in Ohio) can qualify for a MTD payment.
  • ICFs/IID should categorize their services as "Residential Facilities" in field 5 of the application.
  • All providers must submit full-time equivalent data, including home care providers.
  • If a parent organization bills for services by multiple providers under a single tax identification number, the parent can submit revenue information for all of them.
  • Medicaid assisted living providers who also have independent living can include revenue from the independent living community in their application.
Public Health Emergncy extension in the works? The current federal Public Health Emergency, which is the basis for dozens of waivers granted by CMS, expires in late July, but Health and Human Services (HHS) Secretary Alex Azar can extend it for 90 days. Today, HHS spokesperson Michael Caputo posted an interesting tweet that reads, "[e]nough already. @HHSGov expects to renew the Public Health Emergency due to COVID-19 before it expires. We have already renewed this PHE once."

As renewals resume, ODM clarifies Medicaid eligibility post-emergency. With the update of Medicaid Eligibility Program Letter (MEPL) 150 via MEPL 150A, which reinstates renewals, redeterminations, and processing of certain changes in circumstances, OHCA sought clarification on a handful of questions brought forth by the membership. Per Kimberly Fisher of ODM, self-attestation/declaration is still acceptable both for renewals and for intake applications if the individual or the individual’s authorized representative (AR) is unable to get documents to the counties. If a county refuses to accept self-attestation, please contact OHCA, and we will alert ODM. Since MEPL 150 and 150A both state that Medicaid coverage cannot be terminated until the health emergency ends, ODM gave the following answer when asked what happens to the individual’s Medicaid eligibility at that time:

Coverage still cannot be terminated until the health emergency ends. If documents cannot be retrieved, the county should complete the renewal based on self-attestation. If the self-attested information means the individual’s benefits continue with no change, they will authorize and just obtain updated documents at the next annual renewal. If the individual reports changes that would result in a discontinuance, the county has been instructed to add the new information into the case [and] complete an override to ensure coverage continues with no change or discontinuance. With the updated information, the next time a batch is [run] or the case is [run] for whatever reason the new information will be pulled into the case and coverage will be updated at that time. Remember, batches will not be running during the public health emergency and will only be turned on once the emergency ends. Of course, individuals will always receive adverse action (time to remedy the issue before benefits close and/or ask for a state hearing) or provide updated documents so the case can be correct[ed].

ODM hopes caseworkers will let the individual or AR know if there could be an issue once batching begins so everyone can work on a remedy ahead of time. For example:

If family reports having $3,000 in the bank at renewal, caseworker should let the individual and/or AR know that is this will cause the individual to lose eligibility once the health emergency ends. [They should] instruct them to spend down appropriately and provide documentation. [The] case can be updated and there would be no eligibility issue once a batch runs on the case. 

ODM made it clear that the process is the same for new Medicaid applications. If a new Medicaid case was processed through self-attestation and the documents could result in discontinuance of Medicaid, the individual or AR should secure the required documents demonstrating eligibility or spend down to eliminate the risk Medicaid will be discontinued once the emergency ends.

DODD to reinstate ICF requirements. The Department of Developmental Disabilities (DODD) announced that they will put back into place three requirements for ICFs-IID that were waived because of COVID-19. First, the requirement for prior authorization of additional bed hold days will be reinstated per OAC 5123:2-7-08 effective August 1, 2020. All requests for bed hold dates between March 13 and July 31, 2020, for which prior authorization was waived must be entered in DODD’s MyPortal by December 31, 2020, to be approved. Next, providers will be responsible for attesting and certifying ODDPs per OAC 5123:2-7-32 for the September 30, 2020, reporting period end date, and effective July 1, 2020, providers will have to make timely notification of significant changes of condition as required by the rule. Finally, ICFs-IID previously may have been advised to discharge a resident from their roster in MyPortal when a person enrolled in hospice. Effective July 1, 2020, an individual receiving hospice care while living in an ICF/IID should remain on the ICF/IID’s individual roster.

CMS National Learning and Action Network webinar. The webinar for SNFs, entitled "Transparency: Resident and Family Notification," will be held on Thursday, July 2, from 4:00-5:00 p.m. According to CMS, "the latest federal guidance regarding the importance of transparency during the COVID-19 public health emergency will be reviewed. Participants will learn best practices to implement a comprehensive communication plan and strategies to improve transparency and provide compassionate care during challenging times." You may register at this link.