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December 23, 2020

More Vaccination Clinic Lessons Learned. A couple more notes from the early vaccine clinics:

  • It is a good idea to perform a rapid antigen COVID-19 test on any employee who arrives the morning after being vaccinated with a fever. One member who did this found the employee tested positive, so they were excluded from work and potentially avoided infecting others. In a staffing crisis, the Centers for Disease Control and Prevention guidance allows a person with a fever to work, but it is not preferred, and testing is recommended for anyone with symptoms.
  • You do not need to gather prescription drug insurance information (e.g., Medicare Part D) because the pharmacies only bill for the vaccine administration fee, which is covered under medical insurance. The vaccine itself is free.
  • You may want to keep copies of the consent forms from the first clinic together to get a head start on the second clinic.
Other Vaccine News. During the Department of Health (ODH) COVID-19 Vaccination Providers Workgroup meeting today, ODH's Lance Himes repeated that the state's plan is to vaccinate SNF residents and staff under the Pharmacy Partnership for Long-Term Care (PPLTC) first, as Part A, then other congregate settings as Part B. Anyone in the overall Phase 1A who is not included in PPLTC will be covered by local health departments using the Moderna vaccine. Mr. Himes added that Part B will be activated this week. He expected Part B providers to begin being vaccinated in early January, also using the Pfizer vaccine. As a side note, we heard of Part B providers who are being vaccinated now. Ohio's Pfizer allotment for this week grew from 70,000 to 89,700. Next week, the state expects 69,700 more Moderna doses. They did not announce a Pfizer number.

Separately, Governor Mike DeWine announced that school teachers and staff (but not students), people with intellectual and developmental disabilities not in Phase 1A settings, people 65 and over, and those with hereditary disorders will be in the next group to receive vaccinations, possibly starting in mid-January. Others may be added to this phase.

ODH unveiled a dashboard showing numbers of vaccinations by date, location, and age group. They also provided a communications toolkit with a variety of materials to help providers educate their staff members, residents, and families. The materials include a myth-busting page. Last, ODH shared previously-issued guidance to local health departments that emphasizes their responsibility to vaccinate Phase 1A members not included in PPLTC.

Stimulus on Shaky Ground. After we reported yesterday that Congress passed the latest round of COVID-19 stimulus legislation and that it was on its way to President Donald Trump for signature, President Trump tweeted a video in which he severely criticized the bill, which passed both houses of Congress with large, bipartisan majorities. The President stopped short of saying he would veto the measure, but departed for Mar-a-Lago without signing it. His main complaint was the payments to individuals are $600 instead of $2,000. The bill's fate now is most unclear.

Added Clarity on Assisted Living Testing. This morning, Director of Aging Ursel McElroy explained that the new testing guidelines for assisted living communities and SNFs are out. The revised guidelines confirm that the assisted living testing frequency is going to weekly and the SNF testing frequency is going to twice a week for all counties. The guidelines also spell out how state support will be made available for the new testing frequencies. The assisted living test result reporting requirement also moves to weekly instead of biweekly.

The new testing frequencies are effective now. For assisted living, MAKO reportedly is working to get providers more supplies before their new testing dates as shown on the schedule.

Director McElroy told us that the assisted living opt-in/opt-out survey indeed does include the BinaxNOW option, but it only appears if the survey is filled out for an assisted living community that has a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver. The waiver identifier, and thus the BinaxNOW option, are keyed to the residential care facility license number. We learned, however, that the CLIA waiver list incorporated into the survey logic apparently does not include some providers who have waivers. If you have a current Certificate of Waiver but do not get the BinaxNOW option when you come to that part of the survey, we suggest you cancel the survey and report the situation to OHCA.

SNF Prior Authorization Waiver Extensions. Today, OHCA received notifications from managed care plans extending prior authorization waivers for SNF admissions in Ohio as follows:

  • UnitedHealthcare: Waiving prior authorization requirements for in-network SNFs nationwide through January 8, 2021. This applies to Medicare Advantage, Medicaid, and commercial product lines. Admission notification is still required during this time.
  • Anthem Ohio: Prior authorization requirements for Anthem Commercial, Medicare Advantage, and Federal Employee Program admissions to SNFs now are waived through January 15, 2021. Anthem requests that providers submit notification of admission and clinical records by day two of admission.
  • Medical Mutual of Ohio (MMO): Prior authorization for admission to SNFs is suspended through January 31, 2021, for in-network providers. Hospital discharge planning staff still must notify MMO of discharge to a SNF, and SNFs still must notify MMO of admission the following business day with clinical documentation. 

COVID-19 Case Numbers Come Down. Governor Mike DeWine announced that this week's average daily number of COVID-19 cases was 7,598, below the three-week average of 9,852. Deaths from the virus remained high, with 109 more reported today. Likewise, cases in long-term care facilities fell to 7,089 for the week, from a record 8,426 last week. As with the community at large, weekly COVID-19-related deaths in long-term care fell slightly but remained high at 261.

Update on HHS Phase 3 Provider Relief Fund TIN Validations (from AHCA/NCAL). AHCA/NCAL has learned that the Department of Health and Human Services (HHS) plans to contact members that applied for Phase 2 or 3 stimulus relief from the HHS Provider Relief Fund and were initially informed that their application could not proceed due to an ineligible taxpayer identification number. HHS has indicated that this determination was done so in error and will provide an opportunity to apply for Phase 3 funding under a new January 6 application deadline.

Please note that HHS indicated nearly 5,000 applications were deemed ineligible incorrectly but did not share the list of providers that should expect this email from HHS.

Please contact with any questions.