ID/DD Waiver Providers to Receive Additional Funding. Late yesterday afternoon, representatives of the Governor's Office and the Departments of Developmental Disabilities (DODD) and Medicaid (ODM) informed us that the state is arranging $74 million in additional Medicaid funding for ID/DD waiver providers. The funding will cover homemaker/personal care, on-site on-call, and shared living services. This funding is different from the money for ICFs/IID and others included in the Coronavirus Relief Fund distributions through the Office of Budget and Management announced last month. The funding for waiver providers will be a single, supplemental Medicaid payment made in the same way as other Medicaid payments. The state match for the payments will be supplied by the county boards of developmental disabilities and the state. Before the payments can be made, the state will need to have the funding approved by the Controlling Board and to apply for and receive federal approval of a waiver Appendix K submission. These processes will take some time. The methodology for calculating payments to individual providers is not entirely determined yet, but it is likely to be based on each provider's percentage of total Medicaid payments to all eligible providers over a period of time such as March-June 2020. Each provider would receive that same percentage of the $74 million.

Unfortunately, the state's plan does not include enhanced payments to day services and supports providers. State and county representatives pointed out that day providers received a two-week retainer payment earlier and qualify for higher reimbursement for services provided under DODD's current 10-person capacity restriction.

DODD also issued an announcement on this topic.

Test Kit Switch for Certain SNFs. Last night, ODM's Marisa Weisel posted a notice on the Enhanced Information Dissemination and Collection (EIDC) system about a change in delivery of test kits to 70 Cleveland-area SNFs scheduled for repeat staff testing next week. The notice reads:

You are receiving this email because (1) your facility’s first state-supported nursing home specimen collection date is on 8/17-8/19, and (2) your facility is assigned to work with Quest Diagnostics lab. A list of affected facilities is included below the signature of this email.

For this round of testing, instead of receiving test kits from Quest, you will receive a shipment of test kits from the State of Ohio. If you have not already received your shipment of kits, your kits will arrive prior to your testing date. It is important to note the following about this change:

• Quest will be able to process specimens collected with these test kits
• Specimens collected using these kits MUST be refrigerated after collection. Please ignore other guidance from ODH that says “if you use Quest, you don’t need to refrigerate collected specimens”

We expect your test kits for your next round of testing will come directly from Quest.

Please see the EIDC notice for the list of centers affected by this change.

ODH Provides Incorrect MDS/Medicare Coverage Information. In a recorded webinar entitled "MDS 3.0: 1135 Blanket Waivers Review" distributed via EIDC yesterday, Cheryl Moya of the Department of Health (ODH) unfortunately provided some incorrect direction that, if followed, could have negative Medicare reimbursement consequences. Specifically, Ms. Moya addressed the following items:

• MDS coding for isolation. This is a controversial issue nationally because the Centers for Medicare and Medicaid Services (CMS) Resident Assessment Instrument (RAI) Manual requires a patient to be in a private room to be coded for isolation, which carries a substantially higher payment rate. Ms. Moya, however, ventured into another aspect of the isolation definition by stating that a patient must have both symptoms and a positive test. This is incorrect. The RAI Manual, at page 494, specifically states:

Code only when the resident requires transmission-based precautions and single room isolation (alone in a separate room) because of active infection (i.e., symptomatic and/or have a positive test and are in the contagious stage) with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission. (Emphasis added.)

This definition clearly allows coding a patient for isolation if they have symptoms of COVID-19 (see Centers for Disease Control and Prevention guidelines for the current symptom list) but have not tested positive or if they tested positive but do not exhibit symptoms. Contrary to Ms. Moya's comments, this would include a patient who tests negative, but exhibits the listed symptoms, because negative tests are not considered definitive evidence that the patient is not infected.

• Three-day stay waiver. Ever since CMS announced its waiver of the 3-day acute inpatient stay requirement for Medicare coverage of SNF care, there has been confusion about when a patient qualifies for the waiver. From time to time, we have reminded members that the waiver completely eliminates the 3-day stay requirement, but the patient still must meet the established, clinical skilling criteria. Ms. Moya further confused this situation by suggesting that a SNF must determine that the patient would have required a 3-day inpatient stay in absence of the waiver. This requirement is nowhere present in the waiver, which states:

Therefore, SNF care without a 3-day inpatient hospital stay will be covered for beneficiaries who experience dislocations or are otherwise affected by the emergency, such as those who are (1) evacuated from a nursing home in the emergency area, (2) discharged from a hospital (in the emergency or receiving locations) in order to provide care to more seriously ill patients, or (3) need SNF care as a result ofthe emergency, regardless of whether that individual was in a hospital or nursing home prior to the emergency. (Emphasis added.)

CMS interprets patients affected by COVID-19 as including all patients because of the wide-ranging impact of COVID-19 on the health care system (see "COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing," page 103, question 1). There certainly is nothing in the waiver that requires analyzing whether the patient hypothetically would require a 3-day stay if the waiver did not exist. The waiver is open to all patients who meet the skilling criteria.