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June 3, 2020


Controlling Board approves funding for telecommunication grantsOn Monday, the Controlling Board approved a $3 million request from Department of Medicaid (ODM) to provide grants of up to $3,000 to SNFs for devices for patients and families to communicate during the COVID-19 emergency, while visits are restricted. The Centers for Medicare and Medicaid Services (CMS) authorized use of civil money penalty funds for this purpose. ODM tells us they have received 490 grant applications so far and will work to process the requests over the next 2-3 weeks. As applications are approved, ODM will notify the centers and request receipts for the devices. To apply for a grant, please contact Amy Hogan, 614-752-3076, Amy.Hogan@medicaid.ohio.gov.

Senate passes liability protection legislation. The Senate today passed on a party-line vote its own version of liability protection legislation, Senate Bill (SB) 308. While OHCA supported and worked on SB 308 with the sponsor, Senator Matt Huffman (R-Lima), we are very concerned that the Senate Judiciary Committee adopted a last-minute amendment that stripped away a critical part of its protection by exempting wrongful death lawsuits. We believe wrongful death will be a frequent and potentially very costly claim stemming from COVID-19. House Bill 606, which passed last week, includes wrongful death claims in its protections.

SNF reimbursement amendment added to SB 310. The House Finance Committee this evening tacked amendments onto Senate Bill 310 before reporting the bill out of the committee. Among the amendments is a measure that SNF representatives negotiated with the DeWine Administration to reverse Governor Mike DeWine's veto of additional quality incentive funding for SNFs in State Fiscal Year (SFY) 2021, which begins July 1, 2020. The agreement was reached last fall, but the amendment just now found a home. Under the amendment, the new quality incentive would increase from 2.4% of the average per diem rate to 5.2%. In exchange, the measure would repeal the SNF market basket and sunset the quality incentive after SFY 2021. If it passes, the amendment could be worth as much as $90 million in increased reimbursement.

State seeks testing volunteers; provides clarification. Under the state's protocol for notifying SNFs of upcoming testing by the National Guard, they offer at least a week's notice. As a result, none of the facilities in the first "sprint," which are being selected now and have not been notified, will be tested next week. To fill the gap, the National Guard will test volunteers. If you would like to volunteer a center for testing next week, please email CCURT@odh.ohio.gov.

In other testing news, James Hodge of Health said if a local health department tests all of a SNF's staff and residents using a polymerase chain reaction test, the center is exempt from testing by the National Guard. To receive an exemption, the facility should notify the department, on its letterhead, with the date of testing and a statement that the results are available upon request.

Clarification on infection control incentive payments. Toward the end of yesterday's webinar on the testing program, Medicaid Director Maureen Corcoran announced a short-term incentive payment program targeted at infection control. This program, which is for SNFs only, is not fully developed, and we have no more information about it than Director Corcoran shared yesterday. The department has not created or designated a way for providers to submit the attestation that they completed an infection control self-assessment. It also has not stated specifically which self-assessment qualifies. Director Corcoran said the department will have to adopt emergency rules to establish the program and its details. The good news, though, is it is not first-come, first-served, so there is no rush to apply.

PPP Flexibility Act passes Congress. The US Senate today passed unanimously, on its second try, legislation to relax some of the Paycheck Protection Program (PPP) rules. The House of Representatives previously adopted the bill by a 417-1 vote. The key provisions of the Flexibility Act boost the borrower's ability to convert the PPP loan into a grant by lowering the percentage of the loan that must be spent on payroll from 75% to 60% and by expanding the time period for accomplishing this result from 8 weeks to 24 weeks. If the loan does not become a grant, the time the borrower has to repay the loan is extended from two to five years. The legislation is now on its way to President Trump for signature.

Further revisions to PRF FAQs. In what seems like a near-daily occurrence, the Department of Health and Human Services added several new items to their Provider Relief Fund (PRF) frequently-asked questions document. To find them, search the document for "Added 6/2/2020." The new questions and answers deal with such matters as permissible uses of the PRF money, attestation by a parent company on behalf of multiple tax identification numbers, and resubmission of financial information.

Provider flexibilities for CMMI models in response to COVID-19. Today, CMS released a Center for Medicare and Medicaid Innovation (CMMI) Model Flexibilities table outlining adjustments to the current models in response to the COVID-19 public health emergency (PHE). Several of these models apply to post-acute care providers. A summary of the changes to some of the most common models can be found below. Please see the CMS table for more information on additional models, such as Accountable Care Organizations.

  • Bundled Payments for Care Improvement (BPCI) Advanced. CMS gave participants the option to exclude clinical episodes from reconciliation for model year 3 (2020), eliminating the upside and downside risk. Participants that choose to remain in two-sided risk can exclude episodes with a COVID-19 diagnosis.
  • Comprehensive Care for Joint Replacement (CJR) Model. CMS capped episode payments at the target price for episodes with a date of hospital admission between January 31, 2020, and the end of the PHE. CMS also extended the appeals deadline to 120 days for performance years 3 and 4 and through March 2021 for performance year 5.
  • Direct Contracting. CMS delayed model implementation to April 1, 2021, with the second cohort launching January 1, 2022. 
  • Primary Care First Serious Illness Component. CMS delayed the start of the performance period to April 1, 2021. The Primary Care First Only Component will begin January 1, 2021. This program mainly applies to hospice agencies, palliative care providers, and primary care providers.

CMS hosting infection prevention program for SNFs tomorrow. As part of CMS's five-part plan and its continuing effort to provide guidance to SNFs during the PHE, the agency is hosting the first webinar in a new National Nursing Home Training Series. This will be a weekly series focused on infection prevention in SNFs. This week’s topic, which will be presented tomorrow, June 4, from 4:00-5:00 p.m., will cover implementation strategies for COVID-19 surveillance and early detection. The session will feature speakers from the Quality Improvement Organizations (QIOs). Interested providers must register in advance on the CMS event registration portal.

National Hospice Coalition offers free town hall June 11, 2020. The National Coalition for Hospice and Palliative Care will host a free virtual town hall on Thursday, June 11, 2020, at 1:00 p.m., with national palliative care and hospice leaders discussing how the COVID-19 epidemic has changed the delivery of palliative care and hospice – temporarily or perhaps permanently. For more information and to register, click here.

CMS outreach calls to SNFs. The Health Department published on the Enhanced Information Dissemination and Collection system the following notice:

CMS is currently in the process of conducting outreach calls to all nursing homes in Ohio related to infection control.  These will come from CMS staff or contractors with the CMS Survey Operations Group.  All nursing home providers will be contacted. CMS wanted to make providers aware so they will expect the calls.