HHS announces second tranche of CARES Act funding. The Department of Health and Human Services (HHS) posted an announcement that it will begin Friday to pay out the second tranche of funding under the Provider Relief Fund component of the Coronavirus Aid, Relief, and Economic Security Act. Of the $70 billion remaining in the fund, the HHS notice identifies $40.4 billion in payouts, plus an unspecified allocation for care of uninsured COVID-19 patients. $20.4 of the $40.4 billion will be paid to hospitals in hot spots (HHS specifically mentions New York), rural hospitals and health clinics, and the Indian Health Service.
The other $20 billion, like the first tranche of $30 billion, apparently will go to Medicare providers, although the wording ot the HHS notice is unclear: "HHS will begin distribution of the remaining $20 billion of the general distribution to these providers to augment their allocation so that the whole $50 billion general distribution is allocated proportional to providers' share of 2018 net patient revenue." HHS apparently will determine net patient revenue from Medicare cost reports, adding that, "[p]roviders without adequate cost report data on file will need to submit their revenue information to a portal opening this week at https://www.hhs.gov/providerrelief for additional general distribution funds." The formula applied to net patient revenue to generate payment amounts is unknown, as is what constitutes inadequate cost report data.
AHCA speculated further on the distribution: "SNFs are clearly part of a tranche of funds that HHS is using to pay providers based on their total revenue. It will distribute $20 billion of the $40 billion based on a percentage of providers' total revenue, but will make some adjustment for Medicare revenue that was recognized in the prior payment. We do not know the exact formula yet, but providers who have a high level of Medicaid and/or Medicare Advantage will do proportionally better than those who do not."
So whither Medicaid-only providers? They do not appear to be included in the payments described above, probably because HHS did not have sufficient information about them. There should be close to $30 billion left in the fund, and the HHS announcement contains a cryptic sentence: "[t]here are some providers who will receive further, separate funding, including skilled nursing facilities, dentists, and providers that solely take Medicaid."
On a related note, upon passage by the House of Representatives tomorrow, the Provider Relief Fund will receive another $75 billion from "stimulus 3.5." HHS again will have broad discretion to allocate those dollars.
Return of the list. At around 2:00 this afternoon, the Department of Health (ODH) re-posted the list of SNFs, residential care facilities, and ICFs/IID with confirmed or probable positive COVID-19 cases among residents or staff. ODH made some important changes to the new posting. They asked local health departments to verify the data with providers before posting. They separated figures for residents and staff and identified the type of facility. They started the case count on April 15 (leaving out earlier cases) and removed cases that are no longer active. The list is incomplete because a number of COVID-positive facilities are still having their data verified, and facilities from only 18 counties are in included. There also are some remaining errors with the facilities that are listed, so please contact pvanrunkle@ohca.org if one exists for yours, and we will pass it on to ODH.
Finally - blanket waivers for ICFs/IID. Today, the Centers for Medicare & Medicaid Services (CMS) released blanket waivers for ICFs-IID under Section 1135 of the Social Security Act that cover four areas:
- Staffing flexibilities. CMS waived 42 CFR §483.430(c)(4) to allow ICFs to utilize direct care staff to perform functions of direct support staff, but did not waive the minimum staffing ratios specified in §483.430(d)(3).
- Community outings. CMS waived 42 CFR §483.420(a)(11), which requires clients to have the opportunity to participate in social, religious, and community group activities.
- Mandatory training equirements. CMS waived, in part, 42 CFR §483.430(e)(1) to suspend routine staff training programs unrelated to the public health emergency. CMS did not waive §483.430(e)(2)-(4), which require training on clients’ developmental, behavioral, and health needs, interventions for inappropriate behavior, and implementing individual plans.
- Adult training programs and active treatment. CMS waived the continuous active treatment requirement in 42 CFR §483.440(a)(1) when necessary to avoid violating state and local requirements for social distancing, staying at home, and traveling for essential services only.
While the blanket waivers don’t include all of the items OHCA requested in our 1135 waiver, we understand that CMS could issue additional blanket waivers and could waive other items specifically for Ohio ICFs as requested by OHCA or the state.
DODD resources. Yesterday, the Department of Developmental Disabilities (DODD) held two webinars related to the Long-Term Services and Supports Pre-Surge Planning Toolkit that the state published last week. The department’s website contains recordings of both webinars as well as various other useful documents. DODD also scheduled a webinar related to Employment Services and COVID-19 for Tuesday April 28. Interested parties can register here.
Re-opening Ohio. During his daily press conference, Governor Mike DeWine announced that ODH Director Dr. Amy Acton will issue a new order (not yet posted) allowing certain elective surgeries and diagnostic procedures. We have concerns about this decision, coming well ahead of the generally accepted May 1 date for gradually beginning re-opening, because we continue to hear of long-term services and supports (LTSS) providers who do not have sufficient personal protective equipment (PPE). Elective surgeries and procedures will burn PPE that could be directed to LTSS providers who need it to protect against COVID-19.
On another re-opening topic, we confirmed with ODH that the order restricting visitation in SNFs, residential care facilities, and ICFs/IID will not be lifted May 4, as rumored, because of the direct impact on vulnerable populations.
Workers' Comp MCO open enrollment delayed one year. As state-fund employers are aware, every two years there is an open enrollment period for choosing a managed care organization (MCO), and that open enrollment period is always held in May. Due to the impact of COVID-19 on Ohio and our business community, the Bureau of Workers' Compensation postponed the 2020 MCO open enrollment period to May 3-28, 2021. That means your existing MCO will continue to serve you over the next year.
UHC reimbursing for home health telehealth. UnitedHealthcare (UHC) will reimburse services provided by home health agencies using interactive audio/video technology for Medicare Advantage, Medicaid, and individual and fully insured group market health plan members through June 18, 2020. Coverage limitations still apply, as well as any state laws and regulations. UHC will reimburse home health agencies as if the services were rendered in person (place of service home) when billed with modifier 95. Services must be clinically appropriate and in accordance with the plan of care. For more information or billing guidance, please see the dedicated website.
OCR webinar on HIPAA and COVID-19. The HHS Office for Civil Rights (OCR) will host a webinar for health information technology stakeholders on Health Insurance Portability and Affordability Act (HIPAA) privacy and security issues specific to COVID-19 and recent OCR actions related to the pandemic. Topics will include COVID-19 and permissible disclosures under the HIPAA privacy rule, enforcement discretion and guidance for telehealth remote communications, and enforcement discretion for community-based testing sites. The webinar will be held Friday, April 24, 2020 starting at 12:00 noon and is limited to 3,000 participants. Interested parties can register here. If you are unable to register, a recording will be posted on the OCR website within one week.
Aetna extends SNF PA waiver. OHCA previously communicated that Aetna and Aetna Better Health of Ohio both waived the prior authorization (PA) requirement for SNF admissions because of the COVID-19 pandemic. Aetna now has posted a notification extending this waiver to May 6, 2020. Providers still must submit medical records for concurrent review and must notify Aetna of admission within 48 hours.
Anthem, MyNexus PA changes for home health. Recently, Anthem BlueCross BlueShield (Anthem) announced that it will not require prior authorization (PA) for patients transferring to home health from acute inpatient hospitalizations. They still request that providers notify of admission. OHCA reached out to MyNexus, the Medicare Advantage intermediary for Anthem in Ohio. They stated that they have not been directed to waive PA at this time, but to promote accelerated access to care, they will accept retro-authorization requests for up to 5 business days. This policy will expire on May 17, 2020. MyNexus also is establishing a program to reimburse for home health telehealth services. For more information on this program, please contact MyNexus at Provider_Network@myNEXUScare.com or 844-411-9622, option 6.