March 15, 2020
The number of confirmed COVID-19 cases in Ohio and elsewhere in the US continues to grow daily. On television this morning, Governor Mike DeWine said "it would not surprise me at all if schools did not open again this year." He added that an estimated 100,000 people in Ohio could have the virus now, and 40-70% of all state residents eventually could get it.
Three-day stay. The waiver of the three-day stay requirement for SNF coverage is in effect now. See this declaration from Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma. The declaration lists specific circumstances in which the 3-day stay waiver applies that appear to be broad enough to encompass virtually any admission that meets the normal skilling criteria. Here are the circumstances:
(1) Patients evacuated from a nursing home in the emergency area.
(2) Patients discharged from a hospital (in the emergency or receiving locations) in order to provide care to more seriously ill patients.
(3) Patients who need SNF care as a result of the emergency, regardless of whether that individual was in a hospital or nursing home prior to the emergency.
Note that the third reason for waiving the 3-day stay allows for admissions directly from the community without any hospital stay. AHCA is exploring the scope of the waiver with CMS, so please watch for any updates. At this time, though, we believe all admissions that meet skilling criteria are covered.
Updated CDC guidance for long-term care facilities. We recommend members familiarize themselves with and utilize the latest Centers for Disease Control and Prevention (CDC) guidance for long-term care facilities. CDC guidelines are constantly changing, so it is important to check frequently for updates. The current CDC long-term care guidance bears many similarities to the March 13 version of CMS's Quality, Safety, and Oversight (QSO) letter 20-14-NH for SNFs, but has additional information and is better organized. The CDC guidance also applies more broadly than the CMS letter, so all facility-based providers should review it.
Additional DODD guidelines. Yesterday, the Department of Developmental Disabilities (DODD) released two more guidance memos. The first memo explains the availability of statewide DODD support teams to provide technical assistance to providers and county boards. The second memo gives guidance on a number of topics for waiver providers, including important regulatory relief during the emergency. A similar memo for ICFs is coming and may be released today.
DODD also just provided a screening tool for use with employees.
Communal dining and activities. The latest version of QSO 20-14 contains a blunt statement directing SNFs to "[c]ancel communal dining and all group activities, such as internal and external group activities." The same statement also occurs in the most recent CDC guidelines, which are for all long-term care facilities. The directive creates obvious concerns for staffing and quality of life, particularly if the facility is following (as they should) guidance for aggressively screening residents for respiratory infection or potential exposure to COVID-19. The Indiana Health Care Association, with input from OHCA and other state affiliates, developed suggestions for implementing the CMS directive without confining everyone to their room. AHCA is discussing the suggestions with CMS and asked us not to disseminate them to members pending the outcome of those discussions.
Free call Wednesday on HR aspects. OHCA is offering another free all-provider call that will address, through Rob Pivonka of OHCA legal counsel Rolf Goffman Martin Lang, various considerations for supporting staff during the emergency. You should have received a separate communication on the call, but if you did not, please contact us for more information.
Secretary of State voting memo. Secretary of State Frank LaRose issued a memo on voting Tuesday by people in facilities. The memo describes procedures boards of election should use to ensure people can exercise their constitutional right to vote and notes that the Secretary of State worked with the Director of Health on the procedures.
Smile From Home. OHCA asks that anyone who wants to send a smile from home to someone who can’t have visitors, whether they are in a long-term care setting or self-isolating in the community, share a picture or video message with us through any of our social media channels. We will share these throughout the day and encourage our members to share them with those who cannot have visitors. If anyone would like to send anything to our facilities, we ask that you reach out to them first to see what they need and what they can accept.