CLIA Certificate of Waiver Needed to Receive COVID-19 POC Unit. Through communication with the Department of Health’s (ODH's) Clinical Laboratory Improvement Amendments (CLIA) Laboratory Program, OHCA identified a number of SNF members who have a CLIA Certificate of Waiver but were not on the Department of Health and Human Services' (HHS's) original list of waivered SNFs. To rectify this situation, ODH sent HHS an updated list containing what they believe is the most current information on Ohio SNFs with waivers. Remember, only SNFs with active CLIA Certificates of Waiver are eligible to receive one of the complimentary COVID-19 point-of-care (POC) testing units HHS is distributing. We will continue outreach to member facilities that do not appear to have a CLIA certificate, but we wish to share the following tips to help ensure your center is included in this program.

First, please check your facility’s CLIA Certificate of Waiver to make sure it is current and, if it is up for renewal, please take the required steps to renew.

Second, we understand a number of SNFs with CLIA Certificates of Waiver have changed names since they obtained their certificates. If you have experienced a change of ownership, you are required to update your CLIA certificate. According to ODH, you must complete the CMS116 Form as instructed for a “Certificate of Waiver” and mark “Change of Ownership” on the top of the application. Take the completed application, signed and dated, attach a W9 form, and email it to CLIA@odh.ohio.gov. ODH then will mail you a new certificate. 

Finally, ODH’s CLIA Program has no direct involvement with distributing the POC testing units. Their only role is to approve CLIA applications and to report approved SNFs to HHS. As OHCA has the original list as well as the updated list containing what ODH believes is the most current information, please feel free to reach out to Diane Dietz at ddietz@ohca.org should you have any questions about your individual facility.

• Travel advisory. The state's travel advisory is an advisory, not a ban. This means providers are not required to quarantine staff who travel to one of the listed states for 14 days. As discussed today on OHCA's SNF member call, providers try different strategies to mitigate the impact on staffing such as testing employees upon return, requiring them to wear N95s instead of other face coverings, and imposing shorter quarantine periods. The states of concern for travel change each week depending on whether or not they have a positivity rate of 15% or more, so be sure to check the current states whenever a staff member informs you of planned travel.
  
• New hires during SNF repeat testing. According to the state's frequently-asked questions document, a SNF does not have to wait until a new hire's test results come back before they may start work, but they must wear a mask at all times (including breaks) and must not have symptoms.
• Lab requisitions. With repeat testing comes repeat lab requisitions, which are very time-consuming to complete. ODH informed us that the Quest Diagnostics portal retains each staff member's data for recall later. The state is working on similar functionality for their portal, but for now, unfortunately the information must be re-entered each time.
• Temporary nurse aides. We receive questions daily about how long SNFs may continue to use temporary nurse aides. The Centers for Medicare and Medicaid Services (CMS) waiver allowing them to work without completing nurse aide training and testing lasts until the end of the COVID-19 Public Health Emergency (PHE), which is October 23, 2020, unless CMS terminates the waiver earlier. It also is possible that the PHE could be extended further.
• Quarantine and emergency room visits. Per ODH's Bureau of Infectious Disease (BID), a new admission to a SNF who goes to the emergency room during their 14-day quarantine period is not required to start a new 14-day period upon return to the facility. BID wrote, "[t]he recommended observation (quarantine period) is for new admissions and readmissions. Persons going out for appointments (e.g., dialysis, other tests) are not new admission/readmission events so do not need to re-start the observation/quarantine period. The duration of quarantine is 14 days."

DODD Medication Administration Training Update. OHCA received the following notice from the Department of Developmental Disabilities:

In February 2020, a new Medication Administration Certification Category 1 curriculum was published. The original mandatory transition to this tool by July 1, 2020 was postponed due to COVID-19.

At this time RN Trainers need to plan to use only the new curriculum for all training after October 1, 2020. Providers will have until January 1, 2021 to transition all uses of the curriculum to the new January 2020 edition.

The new curriculum can be found on the DODD Medication Administration page.  

CMS Proposed Telehealth Expansion and LTSS Provider Impacts. Last night, we reported that CMS announced several proposed rulemaking actions, including the physician fee rule, which affects telehealth. After reviewing the rule and executive order in further detail, we would like to bring several points to members' attention. As a reminder, these changes are not yet finalized.

1. CMS Administrator Seema Verma reiterated that Congressional action would be required to add eligible billing providers, lift non-rural area restrictions, and expand eligible sites of care. CMS can add types of services without legislation.
2. Expansions adding SNF, therapy, home health, and hospice benefits are covered under the Public Health Emergency (PHE).
3. The proposed physician rule would reduce the required frequency between virtual SNF visits from 30 days to 3 days.
4. CMS proposed to extend the waiver that allows telehealth for SNF discharge visits past the PHE.   This is still only a temporary waiver.
5. The rule would permanently allow physical and occupational therapy assistants to perform maintenance therapy.
6. CMS proposed to reduce outpatient therapy rates by 9%.

Telehealth for physician face-to-face visits has been an invaluable resource for home care and hospice providers during the PHE. Telehealth visits must have 2-way, audio-visual communication to satisfy the face-to-face requirements. 

CMS Delays Deadline for Renewed ABN.  Due to COVID-19 concerns, CMS extending the deadline for the renewed Advanced Beneficiary Notice (ABN), Form CMS-R-131. At this time, the renewed ABN will be mandatory for use on January 1, 2021. The renewed form may be implemented prior to the mandatory deadline.

The ABN Form is issued by providers, including home health agencies and hospices, to Original Medicare beneficiaries in situations where they expect Medicare payment to be denied. The ABN transfers potential financial liability to the Medicare beneficiary in certain instances. SNFs issue ABNs to transfer potential liability for items/services they expect to be denied under Medicare Part B only. The ABN form and instructions may be found at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.

NAHC to Host Free Webinar on Hospice Final Rule. On Thursday, August 6, at 11:00 a.m., NAHC will host a complimentary webinar for members and non-members to provide their insights into the Federal Fiscal Year (FFY) 2021 Hospice Final Payment Rule. In the review, NAHC will take a deep dive into the election statement and addendum requirements effective October 1, 2020. As promised, CMS furnished a model modified election statement and election statement addendum to assist providers with the transition. Click here to register for this complimentary webinar.

CMS SNF Webinar and ODF August 6, 2020. On Thursday, August 6, 2020 at 4:00 p.m., CMS will host their weekly Nursing Home COVID-19 Training, which this week will cover both surveillance to enable early detection and response to outbreaks and the National Healthcare Safety Network (NHSN) mandatory data collection. Advance registration is required. Interested providers may register here.  

Additionally, CMS announced that the next Open Door Forum (ODF) for SNFs also is scheduled for August 6, 2020, starting at 2:00 p.m. During the call, CMS representatives will discuss the FFY 2021 SNF Prospective Payment Final Rule, provide an update on Payroll-Based Journal activity, and cover changes to the MDS 3.0 Item Sets. To participate by phone, dial 888-455-1397 and enter conference passcode 9375124.