HHS Announces (Some) Details of $5 Billion SNF Tranche. The Department of Health and Human Services (HHS) issued a news release late yesterday explaining how the agency plans to distribute the new $5 billion Provider Relief Fund tranche for SNFs that was announced last month. The release does not have anywhere near the level of detail needed for providers to calculate what they will receive. A memo from AHCA/NCAL President/CEO Mark Parkinson elaborates on the HHS release based on a private briefing he received, but as Mr. Parkinson emphasizes, the information he received was verbal and subject to change.

Taking these two sources together, it seems half of $5 billion will be divided among all SNFs in the country via automatic payments that are to be used for testing, personal protective equipment, and staffing. It will be important to keep records of how these dollars are spent for later audit. These payments, which apparently will be higher for centers that have not yet received the point-of-care antigen testing devices HHS is distributing, should be made within the next 10 days.

The other half of the money will be performance-based. Most of it will go to monthly payments from September to December for having no or below-average numbers of COVID-19 cases for the month, as reported via the National Healthcare Safety Network (NHSN). There also apparently will be payments for establishing COVID-19 or quarantine units. Another portion will go to some type of collaborative projects. Interestingly, there is no specific mention of the 23-module infection control training from the July announcement.

OSHA Inspections Increasing: Helpful Information for All Members. We recently learned that in addition to inspecting facilities, most notably SNFs, because of reported employee hospitalizations or deaths, the Occupational Safety and Health Administration (OSHA) now is basing inspections on their review of SNF COVID-19 data reported to the National Healthcare Safety Network (NHSN). Two OHCA members confirmed they were contacted by OSHA requesting copies of their OSHA 300 log and questioning why particular staff deaths reported to NHSN were not reported to OSHA. OSHA Standard 1904.39 requires all employers to report inpatient hospitalizations within 24 hours and fatalities within 8 hours if the event is work-related. Yesterday, OHCA conducted a webinar entitled "Preparing for OSHA Inspections Due to COVID-19" that provided information and resources to help providers comply with key respiratory-related standards and avoid costly citations during an OSHA inspection. This webinar will be available soon for on-demand learning.

To comply with OSHA requirements, it is important to investigate all confirmed cases of COVID-19 within your employee population to determine, to the best of your ability, whether or not the case is work-related per OSHA Standard 1904.5 and, therefore, recordable via the OSHA 300 log and reportable per the timely reporting guidelines stated above. Specific to COVID-19, OSHA released Revised Enforcement Guidance for Recording Cases of Coronavirus Disease 2019 (COVID-19), which became effective May 26, 2020, and provides further guidance on evaluating work-relatedness of COVID-19 infections. You will note that because of the difficulty in determining COVID-19 work-relatedness, OSHA exercises enforcement discretion when assessing an employer’s efforts in making these determinations. Accordingly, good documentation is key to justifying an employer's determination that a COVID-19 case is not work-related. 

OHCA spoke directly with an OSHA Compliance Officer from the Columbus office about recent citations at member SNFs and learned the following important information that was detailed in the Friday webinar:

• All health care providers faced with the possibility of COVID-19 or any respiratory-related employee hazard must have a written respiratory protection program per OSHA Standard 1910.134. According to OSHA, an employer must have a policy covering the standards related to voluntary and required respirator use, hazard evaluation, training, and more to be found in compliance during a COVID-19 OSHA inspection.

• To help members with this, OHCA, through our partnership with CompManagement and Preferred Risk Management Services, created a Sample Respiratory Protection Policy (Word download). We believe this sample policy generally covers the appropriate respiratory protection standards, but it must be customized to your organization.
  

• OSHA communicated another important standard they will cover during inspections: the requirement to conduct a medical evaluation of any employee who wears a filtering facepiece respirator like a N95 or KN95. Regardless whether the respirator is used on a voluntary or mandatory basis, all employees who wear a respirator must undergo an evaluation and complete the OSHA Respirator Medical Evaluation Questionnaire. This evaluation needs to be done by a trained medical professional, which could include your medical director or nurse practitioner if they feel they are qualified. 
  

• With respect to fit testing, OSHA told OHCA they are aware of the challenges health care providers face in obtaining N95s and fit tests. OSHA fit-testing requirements mandate that all employees able to wear a respirator must undergo an initial fit test. Should fit testing for initial use of the respirator be difficult to obtain, OSHA will look for documentation to support your efforts in locating fit tests, including evidence that you placed an order for fit tests, but they are back-ordered.
  

• Per Centers for Disease Control and Prevention (CDC) guidelines, providers can use non-National Instutes of Safety and Health (NIOSH)-approved respirators during the pandemic. The most popular substitute among members is the KN95. Because of their design, it is not possible to fit-test KN95 respirators. If you choose to use KN95s, OSHA will expect to see that they are not on the Food and Drug Administration list of unapproved models (scroll down to "Respirator Models Removed from Appendix A (Respirator Models No Longer Authorized)") and that you follow the manufacturer’s instructions on how to fit and wear the respirator appropriately.

OHCA will continue to monitor OSHA activity and will share news and information as it becomes available. In addition, we will continue to seek the assistance of OSHA consultants to assist our members through our relationships with CompManagement and the Bureau of Workers Compensation.  Please watch in the coming days for the on-demand recording of yesterday's webinar, which you may purchase for additional instruction. 

Upcoming Updates to LTCF COVID-19 Resident Impact and Facility Capacity Module (From NHSN). On Monday, August 10, 2020 updates will be deployed to the NHSN LTCF COVID-19 Module Resident Impact and Facility Capacity pathway. Specifically, new testing questions will be added regarding facility access and capacity for COVID-19 viral testing of residents and facility personnel. The previous questions Does your facility have access to COVID-19 testing while the resident is in the facility? and If YES, what laboratory type? will be removed after August 9, 2020. The updated data collection form, form instructions, and CSV templates will be available on Monday, August 10, 2020 on the LTCF COVID-19 Module web-page. As always, please send all questions to the NHSN Helpdesk: NHSN@cdc.gov with "LTCF" in the Subject line.

Corrected Managed Care Rates Links from SNF News Bites. We apologize that yesterday's SNF News Bites contained two bad links in the article about Medicaid managed care rates. Here are the correct links:

• Department of Medicaid (ODM) memo directing Medicaid managed care plans to pay SNFs at least their fee-for-service rate.
  
• ODM ventilator fact sheet applying this principle to vent rates.