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December 21, 2020

Vaccination Rolls Out in SNFs; Other Vaccine News. Today was the first day of the full-scale COVID-19 vaccination program in SNFs under the Pharmacy Partnership for Long-Term Care (PPLTC). We are interested to hear how the day went for those who were vaccinated today and if there are lessons for other members whose clinic dates are later. We also confirmed that the state intends the so-called Part B settings (all PPLTC-enrolled providers other than SNFs) to be vaccinated after SNFs have at least their first clinic. This appears to be a delay of around 30 days, although it is by no means clear how the process will play out or that it will be uniform across all pharmacies and providers. We recommend members who are on the PPLTC list but have not received clinic dates continue to be patient.

The final steps to authorizing the Moderna vaccine for use were completed yesterday. Ohio expects a large shipment of more than 200,000 doses this week. The Moderna vaccine is similar to the BioNTech/Pfizer version, except that it does not require super-cold storage and it it is approved for ages 18 and older instead of 16. The drastic reduction in the number of Pfizer doses that Ohio is receiving this week is because of an ordering mistake by the Department of Health and Human Services (HHS), not inadequate manufacturing capacity. 

The Health Department released its latest weekly vaccine newsletter, which you may view here.

AHCA/NCAL updated their vaccine frequently-asked questions, which are available here.

On a Centers for Disease Control and Prevention (CDC) update webinar this afternoon, CDC announced that they released this week's Morbidity and Mortality Weekly Report, which focuses on the Moderna vaccine. Like the Pfizer vaccine, Moderna is not contraindicated for pregnant women, people with immune deficiencies, or people who have had severe adverse reactions to vaccinations, but all of these individuals are advised to consult with their clinicians. A fifteen-minute post-vaccination observation period is recommended for everyone except those with a history of adverse reactions, for whom observation should be 30 minutes. The CDC presenters also pointed out that there is no set maximum amount of time between the first and second dose, it just cannot be less than 28 days for Moderna or 21 days for Pfizer. A long-term care toolkit is coming soon, but this obviously will be after vaccination clinics have begun.

Testing Program Changes. Director of Aging Ursel McElroy confirmed again today that the assisted living testing frequency is increasing to once a week. The option in the new survey for biweekly state support does not mean an assisted living community can opt to test every two weeks. It is only about state support. A community choosing biweekly state support must meet the weekly testing requirement through a private arrangement with a laboratory. Other confusing language in the survey suggests that all assisted living residents must be tested at the same time as staff, but Director McElroy clarified that the intent is to retain the strategic approach to resident testing.

The Director also said the testing frequency for SNFs will go to twice a week, as is the case today in most Ohio counties under the Centers for Medicare and Medicaid Services (CMS) requirements. Guidelines spelling out the changes are forthcoming, but have not yet been published. Assisted living communities for the first time will have the opportunity to receive from the state BinaxNOW cards to supplement polymerase chain reaction (PCR) testing, if they have a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver, or they can choose weekly PCR support. For both SNFs and assisted living, the Department of Aging (ODA) will review HHS reports and subtract any BinaxNOW cards HHS provides to a facility from the amount to be distributed via state support. ODA will contact all facilities on shared campuses that elect testing alignment to find out which day they would like to use, but the assisted living testing will not go to the SNF frequency. Only the laboratory (MAKO), supply distribution, and day of the week for testing will be aligned.

New CMS County Positivity Data. This week's CMS county-level positivity data came out today. The Ohio table is again loaded with red, as only 20 counties are yellow. The CMS table is what counts for SNF testing frequency and indoor visitation, not the Ohio colors. We have received a number of questions about the impact of certain counties' purple status under the Ohio Public Health Advisory System on visitation and testing requirements, which is none.

New Stimulus Legislation Set to Pass. Congress is on the verge of passing the first federal stimulus bill since April after months of wrangling. Reportedly the House of Representatives and Senate both will vote on the 5,000-plus-page bill, which also provides for general government spending, by tomorrow morning. The final, $900 billion coronavirus relief portion does not contain liability protection language. Those provisions, along with funding for state and local governments, were split out of the final bill and ultimately jettisoned. A last-minute omission, unfortunately, was the $35 billion addition to the Provider Relief Fund (PRF) that was in the legislation previously. The measure does broaden permissible uses of PRF money and extends states' time to spend existing Coronavirus Aid, Relief, and Economic Security (CARES) Act dollars until December 31, 2021. This spending authority was slated to expire at the end of this year. A major part of the bill is another $284 million for the Paycheck Protection Program. Conventional wisdom is there will be another stimulus bill after the Biden Administration is sworn in, at which time additional PRF funding and possibly liability protection could be addressed.