Exemption from Weekly and Semi-Weekly SNF Staff Testing. The recently-released Centers for Medicare and Medicaid Services (CMS) Quality, Safety, and Oversight (QSO) letter 20-38-NH establishes required testing frequency for SNF staff based on county-level positivity rates. SNFs in counties shown as yellow on the table must test staff at least weekly. In red counties, they must test twice a week. 48 of Ohio's 88 counties are either red or yellow on the current list. CMS allows green county providers to test only once a month, although Ohio requires all SNFs to test bi-weekly. The CMS guidelines contain additional testing requirements for facilities with one or more positive cases (considered an outbreak). We expect these mandates to take effect Wednesday when the CMS rule on this topic is published in the Federal Register.
The CMS guidelines permit an exception to the weekly and semi-weekly routine (not the outbreak) testing requirements. The QSO has a footnote to both testing frequencies that states, "[t]his frequency presumes availability of Point of Care testing on-site at the nursing home or where off-site testing turnaround time is <48 hours." It is not entirely clear what a SNF is to do if they do not have a point-of-care (POC) machine and cannot get turn-around time of less than 48 hours, but it appears that they are exempt from the specified testing frequency. To qualify, the SNF must document all of the following:
- It does not have a POC unit or cannot obtain enough test strips to do the testing.
- Its efforts to contact laboratories to obtain the necessary turn-around time and its lack of success in doing so, including specifying which labs were contacted. The CMS guidance does not establish a number of labs that the center must contact.
- It contacted the local health department.
- It contacted the state health department. While the guidelines do not give the reason for these contacts, the revised survey procedures appended to the QSO indicate that the purpose is to request assistance from the government agencies, presumably in obtaining timely testing.
There is no requirement, however, for up-front approval of the exemption by CMS or the state or local health department. The documentation will be judged after the fact on survey.
CRF Update for Assisted Living; Payment Status. OHCA confirmed with the Department of Medicaid (ODM) that licensed residential care facilities that are also in the MyCare Ohio program need to apply twice to the Coronavirus Relief Fund (CRF) to receive both their individually listed “Assisted Living” and “MyCare” payments from the state. Licensed residential care facilities that offer assisted living services under the MyCare Waiver and applied originally utilizing their Medicaid provider number as instructed will receive only the payment marked “MyCare.” To receive payment under the field “Assisted Living,” the licensed residential care facility will need to apply again using their license number.
In other CRF news, we understand another set of payments will be made tomorrow, based on additional data matching by ODM and the Office of Budget and Management. These payments should bring the total outlays close to $200 million. The two agencies continue the matching work - which mainly revolves around provider names and addresses - and also will reject an application if there is a mismatch of identifying numbers. In those cases, the provider must re-apply with corrected information.
ODH Order Re-Opening Adult Day Care Centers and Senior Centers. Some eleven days after Governor Mike DeWine announced that the state would allow adult day care and senior centers to re-open on September 21, the Department of Health (ODH) issued an order to that effect. Please note that this order does not apply to day services for people with intellectual and developmental disabilities, which are subject to separate requirements under the Department of Developmental Disabilities (DODD). The order for senior adult day services is eight pages long and establishes much more detailed requirements than previous directives affecting long-term services and supports, even with their accompanying guidelines. A couple of key aspects are that the order does not establish any specific capacity limitation, instead relying on provider discretion in compliance with social distancing requirements, and that all participants and staff must have COVID-19 tests under Department of Aging guidelines before returning to the setting. There are dozens of additional requirements, however, so OHCA members offering adult day care should review them carefully and prepare appropriately before September 21.
Progress Continues on Indoor Visitation in ICFs/IID. As we reported previously, the requirements and timing for indoor visitation in ICFs/IID will be separated from SNFs and assisted living. Currently all three facility types are covered by the same amended ODH order. We anticipate that indoor visitation will be permitted sooner in ICFs based on special considerations applicable to them. We also believe that ICF operators will have the discretion to decide whether to allow visitation based on their consideration of specified factors and subject to minimum safety standards set by DODD. At a meeting with DODD on Wednesday, stakeholders will discuss a new draft of the indoor visitation requirements, which appears to address a number of the concerns OHCA raised. DODD has not announced an effective date for a revised order, as this decision lies with Governor DeWine.