Elevating the Post-Acute and
Long Term Care Profession

April 12, 2021

Gray Over Ohio. This week's Centers for Medicare and Medicaid Services (CMS) county-level positivity table shows all of Ohio's 88 counties as gray. Gray shading is a convention CMS uses when a state does not submit adequate data. A legend at the top of the positivity table reads:

Counties that are classified as gray have not submitted testing data for this time period. Counties in OH and ME have also be classified as gray due to incomplete reporting such that percent positivity cannot be calculated. Please refer to the state COVID-19 website for data on gray counties.

Ohio does not publish county-level positivity data, only state-level, so CMS's suggestion does not help here. The CMS table does include positivity percentages, despite the statement that the positivity cannot be calculated. These percentages would appear to be invalid because they are not accompanied by color ratings. We are attempting to get clarification of how to interpret the gray designation for visitation, testing, and personal protective equipment. Our recommendation at this time is to continue using last week's color ratings.

SNF Annual Surveys Restart Today. Early this morning, we began to hear from members about annual surveys starting back up today. Rebecca Sandholdt of the Department of Health confirmed that around 10 annuals are on tap this week. We have not yet received any feedback from members about changes in the process for annuals, as we understood there would be some. We also have not confirmed if residential care facility surveys are restarting at the same time as SNFs.

CMS Provides Guidance on Temporary Nurse Aides. The most popular question, by far, that we receive at OHCA is some variation on, "what will happen when the authorization for temporary nurse aides (TNAs) expires?" Until now, our answer was that we expected the CMS waiver allowing use of TNAs to continue as long as the federal Public Health Emergency (PHE) and that we were working on state legislation to provide a pathway for TNAs to become state-tested nurse aides (STNAs). Now there is an official answer, or at least part of an answer. CMS issued QSO-21-17-NH, which addresses the nurse aide training waiver along with three others. Unlike the other three waivers, which CMS is terminating effective May 10, 2021, CMS specifically stated they are not terminating the nurse aide waiver. Instead, CMS urged states to address what will happen when the waiver ends and clarified that the 4-month period for a nurse aide to become certified (an STNA in Ohio parlance) will start when the waiver ends. CMS did not specify when the waiver will end, but we believe it will be relatively soon or CMS would not have felt the need to address it in the QSO.

CMS provides important guidance on how TNAs can become STNAs, writing about the federal nurse aide training requirements:

While these federal requirements specify the topics and number of hours that the training must include, the federal requirements do not specify how the training must be delivered. For example, federal requirements do not specify whether the content must be delivered via classroom-style training versus in a nursing home setting. CMS acknowledges that training on many of the topics stated in the federal requirements can be obtained in the nursing home setting through onsite observation and working as a nurse aide under the blanket waiver. Therefore, CMS recommends that states evaluate their [nurse aide training and competency evaluation program], and consider allowing some of the time worked by the nurse aides during the PHE to count towards the 75-hour training requirement. However, states must ensure that all of the required areas of training per 42 CFR §483.152(b) are addressed, and any gaps in onsite training that are identified are fulfilled through supplemental training. Lastly, nurse aides must still successfully pass the state’s competency exam per 42 CFR §483.154.

This guidance is extremely helpful because it closely matches the legislative approach OHCA was pursuing and gives it explicit federal support. We will need to adjust our legislation to account for the testing requirement, although AHCA/NCAL's Pam Truscott suggested today that there may be flexibility for the state to change the testing requirement for TNAs.

The three waivers that CMS will terminate next month are those on notice of discharge and room changes for cohorting purposes, care planning, also relative to cohorting, and submission of MDS records. CMS explained in the QSO why they do not believe these waivers are still needed.

Aetna Reprocessing COVID-19 Test Claims. Through the OHCA SNF Billing Committee, we identified a systemic issue with Aetna MyCare Medicare's processing of claims for COVID-19 point-of-care tests under code 87426QW. Aetna is completing a mass adjustment for all claims affected, and providers should begin seeing payments this week. As a reminder, surveillance testing is not covered by Medicare, while outbreak testing is. Tests for managed Medicaid-only beneficiaries also should not be reimbursed. Please allow time for Aetna to reprocess your claims before resubmitting them. For questions regarding this or related issues, please contact Erin Begin.

FDA Recommends Dropping N95 Decontamination. The Food and Drug Administration (FDA) posted a letter to health care personnel and facilities on their website recommending providers discontinue decontamination and bioburden reduction treatment of disposable respirators, specifically N95s. FDA wrote that they believe there is a sufficient supply of respirators, so contingency and crisis capacity measures no longer are neeeded. They recommended instead increasing supply of N95s and employing reusable elastomeric and powered air-purifying respirators. FDA did not repeal the Emergency Use Authorizations for decontamination and bioburden reduction systems in the event supplies of respirators again become constrained.