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December 17, 2020

Vaccine Preview in SNFs Tomorrow; Other Vaccine News. The state selected a few SNFs across the state to receive COVID-19 vaccine tomorrow in an early entry of the Pharmacy Partnership for Long-Term Care, which begins more broadly on Monday. According to the DeWine Administration, this preview is to include 5-10 SNFs. We are aware of 6, but there could be others. We anticipate Governor Mike DeWine and Lieutenant Governor Jon Husted may be involved in the roll-out.

Typical of this rapidly-developing story, we learned today that some members (e.g., assisted living communities) that are not SNFs were scheduled for vaccinations in the next two weeks. This ran counter to what we understood yesterday, which was that only SNFs would be included for approximately four weeks. We urge members to continue letting us know as their vaccine clinics are scheduled.

This afternoon, the federal Vaccine and Biological Products Advisory Committee recommended to the Food and Drug Administration that it grant Emergency Use Authorization (EUA) for Moderna's COVID-19 vaccine. The committee made the recommendation by a vote of 20-0, with one abstention, a strong endorsement of the vaccine's safety and efficacy. If last weekend's action on the Pfizer/BioNTech vaccine is any indication, all necessary approvals for the Moderna vaccine could be in place by Sunday, with shipment beginning immediately after. Based on what we know now, in Ohio the Moderna vaccine would not enter the Pharmacy Partnership for Long-Term Care but would go to local health departments and others to vaccine additional members of the Phase 1A population. This population would include staff and residents of congregate facilities that are not in the Pharmacy Partnership and home care and hospice agency staff.

ID/DD Waiver Funding-Related Amendment. Today, in what most likely is the last day of the General Assembly's lame-duck session, the legislature took an inconspicuous action that smooths the way for important relief to ID/DD waiver providers. The Ohio Association of County Boards of DD (OACB) approached OHCA a couple of weeks ago with a plan to provide state matching funds for a Medicaid provider relief payment to residential waiver providers (homemaker/personal care and shared living), similar to the payment this summer. Together with OHCA and the Ohio Provider Resource Association, OACB secured the DeWine Administration's agreement to submit another Appendix K amendment to the Centers for Medicare and Medicaid Services (CMS) to authorize federal matching funds. Adult day and non-medical transportation providers were added to the mix, with the total funding currently estimated at $77 million.

The next challenge was when the Department of Developmental Disabilities reported that they needed the legislature to increase their spending authority so they could process the payments, even though they do not include any state funds. The Administration and associations rushed to secure an amendment raising the spending authority before the legislature adjourned, which succeeded today. A House-Senate conference committee added the amendment to Senate Bill 310, which is the vehicle for the state's capital spending bill, along with other COVID-19-related amendments. After this legislation is signed, the next step to delivering much-needed financial assistance to waiver providers is for the state to draft and submit the Appendix K proposal for CMS review. That process moved quickly in the summer, so we are hopeful it will be the same now.

CMS Issues QSO-21-07 for ICFs/IID. Today, CMS issued Quality, Safety, and Oversight letter (QSO) 21-07-Psych Hospital, PRTF & ICF/IID entitled, “COVID-19 Infection Control for Psychiatric and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID).” The QSO starts out by stating, “[p]roviding care to patients and clients in Psychiatric hospitals, PRTFs and ICF/IIDs present unique care considerations and associated infection control challenges during the COVID-19 Public Health Emergency (PHE). CMS is providing additional clarification and guidance to improve infection control practices to assist in preventing the transmission of COVID-19, and to help avoid the need for use of seclusion and restraint, specifically as an infection control intervention.” 

The QSO contains 12 pages of frequently-asked questions (FAQ) and CMS’s responses. Many of the responses in the FAQ are recommendations or things to consider related to infection control, encouraging people to participate in infection control measures, and preparing for successful discharges and transfers. While paying attention to seclusion or restraints seems to be a persistent theme in the FAQ, one particularly notable CMS directive is, “[a]ll new admissions should be quarantined on admission for 14 days. People living with others in facilities and other congregate living arrangements who are unable or unwilling to isolate or cohort need to be separated from non-infected people by placement in separate living areas. For more information on nursing home infection prevention and control see:” This is the first time that ICFs have been directed by CMS to quarantine new admissions. ICF providers should review the QSO and embedded FAQ to determine what impact, if any, they will have on your current policies and procedures.

Monoclonal Antibody Treatment Update. During our weekly call with the Ohio Medical Director’s Association (OMDA), OHCA received information about distribution of and access to monoclonal antibody treatments for SNF patients. Chris Laxton of the American Medical Directors Association described the new Special Projects for Equitable and Efficient Distribution (SPEED) from the Department of Health and Human Services (HHS), which aims to assist states and territories with identifying and allocating monoclonal antibodies (mAbs) to non-hospital facilities that serve priority populations, including SNFs.  We reached out to potential distributors to gain more details about the availability of treatments and will send contact information as soon as we have confirmed availability. Mr. Laxton also described a process whereby a SNF with drug compounding capabilities could obtain the treatment directly by utilizing this form. Additionally, AMDA provided these resources for mAb education:

Independently, OHCA was contacted by Coram Infusion/CVS Health regarding a pilot for SNF patients to receive mAb treatments. To be eligible, SNFs must be within 80 miles of Solon, Ohio. Coram will hold an informational webinar for eligible providers on Tuesday, December 22, at 4:00 p.m. The call has limited attendance capacity. If your facility falls within the geographical area, please contact Erin Begin for call-in information. 

CDC Call on COVID-19 Vaccine Response December 21. The Centers for Disease Control and Prevention (CDC) is inviting health care stakeholders to join their weekly partner call for updates on the COVID-19 response, including new resources for the private sector and the general public, on Monday December 21, 2020, at 3:00 p.m. You can register for the call here.