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June 2, 2020

State holds webinar on testing program; announces incentive funding. Personnel from the Departments of Medicaid, Health, and Aging conducted a webinar this morning for all Ohio SNFs. The agency officials outlined the mandatory testing program for SNF staff and some residents, described the June 8 re-opening of visitation at assisted living communities and ICFs/IID, and announced an incentive payment program for SNFs that relates to infection control. The state still has not completed guidance on two key aspects of the testing program, the return-to-work criteria for staff and who will pay for employee testing, although Medicaid Director Maureen Corcoran said the state hopes to seek payment from employees' health insurance. The state staff also did not address how patients will be selected for testing, but did explain that centers will be notified 1-2 weeks before testing and described the communication process leading up to testing day. In addition to guidance, the state plans to issue a set of frequently asked questions and answers. OHCA is compiling a set of questions that we will submit tomorrow.

Relative to funding, Director Corcoran said the Department of Medicaid is creating a $25 million incentive program. Part of the money will be paid to SNFs that self-attest that they completed an infection control self-assessment using the Centers for Medicare and Medicaid Services (CMS) assessment form and are addressing any identified weaknesses. These providers will receive $10 per day for their April Medicaid days. The other part of the money will go to SNFs that have infection control focus surveys that result in no deficiencies over F level. Per a CMS table released yesterday, 293 of the Ohio's 953 SNFs have had infection control surveys. Yesterday's Quality, Safety, and Oversight letter 20-31-All requires surveyinng 100% of SNFs across the country by July 31.

AL/ICF Visitation guidelines released. As noted above, re-opening visitation to assisted living communities and ICFs/IID was a part of the state's webinar, as Aging Director Ursel McElroy explained the changes that take effect June 8. At the time of the webinar, neither the amended Director of Health order nor the guidelines for visitation had been issued. Later today, the guidelines came out, but still not the order. The Health Department guidance applies equally to ICFs and assisted living. The single-page document requires visitation to take place outside and in accordance with facility policy and mandates visitors are screened, wear masks, and take other precautions. Visitation to SNFs remains prohibited, but the state loosened the definition of end of life for all settings, including SNFs: "[p]roviders should notify family members several days and up to one week in advance of when a substantial change of condition has occurred and end-of-life is approaching. Providers should not wait until active dying to allow visitors."

In lieu of visitation, the Centers for Disease Control and Prevention issued a document entitled "CORONAVIRUS DISEASE 2019 (COVID-19): Supporting Your Loved One in a Long-Term Care Facility" with a number of tips. These are generally well-known and in frequent use, but we share the document with you because of its official imprimatur.

Provider Relief Fund deadline tomorrow. The Department of Health and Human Services (HHS) posted the following alert on their Provider Relief Fund (PRF) web page:

ALERTProviders need to take action by June 3, 2020. Providers must submit revenue information to the General Distribution Portal by June 3, 2020 to be considered for an additional payment from the Provider Relief Fund $20 billion General Distribution. Once providers submit their revenue information by June 3, 2020, if deemed qualified for additional payment, providers will then have 90 days from receipt of payment of the additional General Distribution funds to agree to the program Terms and Conditions.

HHS again uses the confusing term, "additional payment," which can be read to suggest a payment beyond what the provider already received under the first two PRF tranches. The embedded link in the alert, however, points to HHS's May 20 notice that gives two meanings to additional payments: payments providers automatically received under the second tranche and payments to providers who did not receive anything from the second tranche but are requesting a payment based on lost revenue. Both groups of providers need to submit their attestations and financial information by tomorrow.

If you have any?questions about the PRF, please contact the HHS hotline at 866-569-3522.

CMS Approves Additional 1135 Waivers: CMS issued an approval letter to Director Corcoran for additional items from Ohio’s previously submitted, combined 1135/Appendix K waiver request. The latest CMS approvals waive the requirement to receive written consent for certain person-centered plans, modify deadlines for both initial and annual level of care (where applicable), and allow all new admissions to SNFs to be treated as exempted hospital discharges for the purpose of Pre-Admission Screening and Resident Review (PASRR). The approval letter also states, “CMS continues to work on additional waiver or modification requests....”  As additional approvals are received, OHCA will share them with members.