CARES Act grants. If you are a Medicare provider, you should have received an email notification today that $30 billion in Coronavirus Aide, Relief, and Economic Security (CARES) Act grants are being distributed to all providers who had Medicare business in 2019. You already may have received a direct deposit of the dollars. See this Department of Health and Human Services (HHS) page for more information. The grants amount to approximately 6.2% of each provider’s Medicare fee-for-service billings in 2019. Medicare managed care is not included. The grants do not need to be repaid, as is the case with the accelerated advance Medicare payments. Providers receiving CARES grants must agree to the terms and conditions within 30 days after receiving the money. HHS indicates that the remainder of the total CARES Act health care fund of $100 billion will be distributed to providers with low Medicare volume or high uncompensated care.
ODH rule waivers. The Health Department (ODH) today issued several rule waivers that OHCA requested. In some cases, the waivers follow up on 1135 blanket waivers from the Centers for Medicare and Medicaid Services (CMS). The ODH waivers pertain to the following:
- Hospice: ongoing assessments can be by telehealth (but see article below); 15-day timeframe for plan of care review; volunteers to provide direct patient care; two-week nurse supervisory visits; and provision of therapy.
- Residential care facility: notice of room change; timeliness of assessments and re-assessments; and space requirements to accommodate emergencies.
- Skilled nursing facility: notice of room change; physician visits can be by telehealth; timeliness of assessments and re-assessments; and space requirements to accommodate emergencies.
It is our understanding that there may be a couple more waivers coming soon, one of them relative to nurse aide training.
Central Ohio swab teams deploying tomorrow! A brand-new COVID-19 testing program for long-term services and supports called Post-Acute Regional Rapid Testing (PARRT) is launching at 8:00 a.m. tomorrow morning. The program consists of a call center operated by National Church Residences that dispatches swab teams on request of central Ohio SNFs and assisted living communities to collect samples for testing at the ODH laboratory. This process will facilitate quick sample collection and test results at no cost to providers. Please see the Facility Information Sheet, which contains a straightforward set of instructions for participating. These instructions explain that to improve the efficiency of the program, you should fill out the Microbiology Specimen Submission Form before arrival of the swab team. This form will be taken to ODH with the swab sample. Post the Quick Information Sheet in your nurses station or other locations as it contains the call center number: 888-344-9222.
Recruiting? Use COVID-19 (Coronavirus) Job Search website. The state created this job posting site for employers to reach potential employees displaced by COVID-19. If you need workforce that may or may not have a health care background, give this heavily promoted site a try. For a site specific to long-term services and supports positions, use OHCA's Ohio Care for the Aging. For direct support professionals in the developmental disabilities field, try DSPOhio.
AHCA/NCAL, NHPCO team up on hospice guidance. AHCA/NCAL and the National Hospice and Palliative Care Organization jointly issued guidance on hospice services for facility patients and residents during the COVID-19 emergency. The organizations agree that determinations about visits should be made on a case-by-case basis, balancing limiting entry into with patient needs.
More on hospice and facilities, use of telehealth. There is some confusion in the field about the CMS blanket waiver for telehealth for routine hospice home care. While the waiver allows hospice agencies to use telehealth, they cannot report telehealth visits on claim forms. They also cannot substitute telehealth for in-person visits unless specifically ordered on the plan of care. CMS states in their interim final rule, “we do not believe that direct patient care for Medicare hospice patients will typically be furnished via telehealth." Per an ODH statement, “it is important that the healthcare needs of your residents continue to be met during the critical time.” As discussed in the AHCA/NCAL/NHPCO guidance above, depending on the circumstances, hospice staff can be essential health care personnel who need to be able to meet their Conditions of Participation as well as to provide care to their patients.
CMS issues additional waivers for home health and hospice. Late last night, CMS posted a summary of their COVID-19 1135 blanket waivers that includes new waiver authorities for home health and hospice providers. These waivers are effective retroactive to March 1, 2020.
- Home health: allows occupational therapists to conduct the initial and comprehensive assessments, regardless whether the occupational therapy is the service that establishes eligibility for the patient to receive home care (42 CFR 484.55 (a)(2)) (42 CFR 484.55 (b)(3)).
- Hospice: waives the 12-hour in-service requirement for hospice aides (42 CFR 418.76 (d)) and allows the use of pseudo-patients, such as a person trained to participate in a role-play situation or a computer-based mannequin device, for aide competency testing (42 CFR 418.76 (c)(1)).
Don't be fooled by CDC critical infrastructure worker guidance. CDC guidelines on safety practices for critical infrastructure workers exposed to COVID-19 may be confusing because the guidance establishes lower return-to-work thresholds than previous guidelines for health care workers. Please note that these guidelines do not apply to health care workers despite the somewhat unclear meaning of critical infrastructure. Return-to-work criteria for health care personnel are found in separate CDC guidance and are more stringent because they are in close contact with vulnerable people.
ODA COVID-19 Updates: The Department of Aging (ODA) announced updates for waiver servicesin the emergency period. New Structural Compliance Reviews for existing providers are suspended for 90 days. Reviews currently in process will be completed. New provider applicants will be desk-reviewed. ODA provided an updated Case Management Emergency Protocol and frequently-asked questions document with changes relating to telephone assessments, including allowing assisted living staff to provide information for inaccessible residents, extension of service plans, clarification of home-delivered meals limits (two meals per day plus blizzard boxes), and suspension of disenrollments.
COVID-19 resources for CPR training. The American Heart Association released new Oxygenation and Ventilation of COVID-19 Patients modules this week. The materials in this toolkit are quick resources and refreshers for healthcare providers who may be called to assist in critical care roles beyond their routine daily activities for COVID-19 patients. The modules review non-invasive support, airway management, ventilation equipment, and ventilation management for COVID-19 positive patients.