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December 22, 2020

Lessons Learned from Vaccine Early Adopters. Today on our SNF member call, two members shared their experiences with vaccination clinics. One had CVS as their pharmacy partner, the other Walgreens. Some insights they offered:

  • Do not use the CVS online consent form. They need to have their triplicate form completed. Walgreens, on the other hand, uses a front-and-back vaccine administration record (VAR) form. CVS required documentation of verbal consent; Walgreens only asked facility staff to write "consent obtained" on the VAR form.
  • The process demands dedicating several facility staff members to assist with registration and room-to-room vaccination.
  • The pharmacy will collect and verify insurance information before vaccinating anyone, so the actual start time will be delayed.
  • Each member reported high vaccination rates for residents (90% or more) but only about 50% of staff. Both said they expect more staff to participate at the second clinic, although waiting isn't ideal.
  • Neither member reported vaccine recipients experiencing much in the way of side effects. There was only one call-off today between the two buildings.
  • Each shot takes up to 10 minutes, but it could be less depending on the process the pharmacy uses to prepare each dose.
  • The clinic may require more space than the pharmacy suggests.
  • There were differences in how assisted living on the same campus as a SNF was handled. In one case, the assisted living was vaccinated, in the other, it was not. This may have stemmed from differences in how the providers signed up.
  • Both members reported that their pharmacies were willing to provide the second dose to short-term patients who discharged before the second clinic, although a third member reported on the call that Walgreens said they would not do so.

More on Federal Stimulus Legislation. As expected, both the House of Representatives and the Senate passed the new stimulus legislation, coupled with a measure to fund the federal government through next September. There are many provisions in the stimulus bill, but the following are a few that are relevant to long-term services and supports providers:

  • Adds only $3 billion, instead of the expected $35 billion, to the Provider Relief Fund, and calls for using at least 85% of the remaining money in the fund and any recoveries to compensate providers, upon application, for losses in the second half of 2020 and first quarter of 2021.
  • Continues the sequester waiver until March 31, 2021.
  • Extends until December 31, 2021, the ability of states to use Coronavirus Relief Fund (CRF) money. We are investigating with the state whether they will extend the deadlines for providers to use the CRF money or to apply for grants for air-purifying equipment.
  • Increases certain Part B fees, including therapy, by 3.75% to offset partially the cuts recently imposed by the Centers for Medicare and Medicaid Services (CMS).
  • Adds $284 billion to the Paycheck Protection Program and allows businesses that already received a loan to apply for another.
  • Allows Department of Housing and Urban Development (HUD) loans to cover a year of operating losses.
  • Allows CMS to use other measures than rehospitalizations for the SNF Value-Based Purchasing program.
  • Adds some aspects of the shelved Medicaid Fiscal Accountability Regulation (MFAR) to the statute.
  • Continues the Money Follow the Person program (HOME Choice in Ohio) for 5 years.
See the AHCA/NCAL summary and this broader summary of the stimulus provisions from the House Democrats for more detail.

Assisted Living Testing Confusion. The Department of Aging (ODA) made changes to its opt-in/opt-out survey for state support for assisted living testing that added to the confusion resulting from premature release of the survey before new testing guidelines were ready. The new version of the survey links to December 21 guidelines - which are not updated. Moreover, the revised form appears to withdraw the partial opt-in testing option that ODA listed in their announcement last Friday and included in the original survey. At the same time, the testing schedule for assisted living appears to be updated to reflect a weekly testing requirement starting January 1 and continuing through January 15. Members may wish to refrain from completing the survey until it is clarified.

Update on Monoclonal Antibody Access. OHCA confirmed with most of the long-term care pharmacies listed below that they are in discussions with the Centers for Disease Control and Prevention and the Department of Health and Human Services on the federal initiative to distribute monoclonal antibody treatments:

Absolute Pharmacy
Complete Pharmacy Solutions
Diamond Pharmacy
Institutional Care Pharmacy
Pharmscript of NY
Remedi SeniorCare
Lifeline Institutional Pharmacy
Choice Pharmacy
Harvest Grove LTC
Procare LTC Pharmacy
RX Institutional Services
Skilled Care Pharmacy

While the pharmacies do not have the treatments yet, you should review the list to see if your pharmacy may have the treatment in the near future. Most pharmacies have indicated that they intend to inform their clients once they receive treatments. Facilities should be prepared in some cases to administer the treatment with their internal staff. However, the federal SPEED project also is developing a dedicated infusion team to assist with administration. Treatments can be delivered in SNFs, at home, or in assisted living facilities. 

On a related note, Coram held a call today for facilities within 75 miles of their location in Solon, Ohio. They currently are accepting referrals for monoclonal antibody treatments within the servicing area when clinically appropriate. The dedicated intake line is 866-316-0264. Coram will administer the infusion as part of the pilot, which runs through March 2020. Coram also stated that they are recruiting home health agency infusion providers who can partner on infusion administration during the pilot.

For more information on monoclonal antibody treatments, please see the resources below:

DODD Delays Several Initiatives. The Department of Developmental Disabilities (DODD) announced today they will delay implementation of the Ohio Individualized Service Plan and Assessment (OISP) and will suspend compliance reviews. This comes after DODD’s agreement with stakeholders to pause the BluePrint in Adult Day and Employment Services Workgroup and in response to requests from stakeholders such as the letter OHCA sent DODD last Friday. DODD states in the announcement:

Ohio ISP - We will look for the implementation to begin in late summer of 2021. This will allow us to properly test the assessment, plan, and on-line platform while preparing to train all parts of our system thoroughly and collaboratively before implementation.

Provider Compliance and County Board Accreditation Reviews - Resumption of these reviews will be scheduled for March 1st, 2021. Special reviews will continue throughout the intervening period as needed.

Blueprint for Adult Day and Employment Services Work Group - Work Group activities will resume in Spring of 2021.