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June 5, 2020

Visitation order finally appears. More than a week after Governor Mike DeWine announced he was re-opening ICFs/IID and assisted living communities for outdoor visits, and several days after the Health Department (ODH) issued visitation guidance, Director Dr. Amy Acton released an amended version of her order reflecting the change. As expected, the order is similar to the guidelines, but it contains clearer language explaining that the decision to allow outdoor visits lies with the facility. "Effective June 8, 2020, Residential Care Facilities (RCFs) and ICF/IIDs may permit residents to have visitors in outdoor settings in accordance with the guidelines set forth below." (Emphasis added.) The order also more fully addresses the newly relaxed end-of-life definition:

[E]nd of life situations are defined as a substantial change of condition indicating end of life is approaching. Providers shall notify family several days and up to one week in advance and shall not wait until active dying. Some indications of end of life include the following: loss of appetite (no eating or drinking), increased sleeping, delirium, unexplained agitation, mottling of skin, significant decline in cognition, or an increase in depression accompanying other indications.

This definition applies to all three regulated settings (SNF, assisted living, ICF). The other provisions of the Director's March 13 order (e.g., essential personnel, screening) remain in effect via the amended order.

DODD guidance. The Department of Developmental Disabilities (DODD) released multiple guidance documents and updates this evening. Related to the ICF visitation order referenced above, DODD released additional ICF visitation guidance. ICF providers will need to ensure that they consider the ODH order, Responsible RestartOhio guidance, and the DODD ICF visitation guidance when determining whether and how to allow outdoor visitation. DODD also issued new visitation guidance for waiver providers that allows both indoor and outdoor visitation after conversations with support teams and roommates to determine when and how to resume visitation. In addition, DODD advises providers who operate camps to follow the Responsible RestartOhio guidance for residential or day camps. Related to transportation, DODD rescinded their previous non-medical transportation guidance and now advises providers to follow ODH, local health department, or Centers for Disease Control and Prevention (CDC) directions. While the previous transportation guidance is rescinded, OHCA is talking with DODD about the issue. We believe additional transportation guidelines may be forthcoming. Finally, the department reminded providers that the medication administration guidance allowing personnel with expired certifications to administer medications for up to 180 days expires on August 1, 2020. Any staff with expired medication administration certification no longer will be allowed to pass medications beginning August 1, 2020.

Advice on NHSN reporting issues. If you have concerns about the accuracy of CDC's reporting of data you submitted to the National Healthcare Safety Network (NHSN) or you still are unable to register with NHSN or to submit data, please see these AHCA posts:

Another PRF FAQ. Just when you thought it was safe to go back in the water, the Department of Health and Human Services (HHS) issued another update to their frequently-asked questions document on the Provider Relief Fund (PRF). This time, HHS again tried to clarify the mysterious June 3 deadline. See the questions and answers at the bottom of page 20 and top of page 21. HHS explains that the June 3 deadline was only for submitting financial information to qualify for a portion of the second PRF tranche, not for attesting to receipt of payment and agreeing to the Terms and Conditions. The deadline for the attestation is 90 days after receiving the money.