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December 28, 2020


President Trump Signs Stimulus Legislation. After several days' delay, during which time he cast aspersions on the massive bill, President Donald Trump yesterday signed the Consolidated Appropriation Act, which combines COVID-19 stimulus and general government funding provisions. The President does not have line-item veto authority as does the Ohio Governor, so the entire bill went into effect immediately. Here again is a link to the AHCA/NCAL summary of relevant items in the stimulus portion of the bill.

On a call with state affiliates today, AHCA/NCAL's Mark Parkinson emphasized the 3-month extension of sequester relief (which could be extended further) and the broadened definition of lost revenue for Provider Relief Fund (PRF) expenditures. He felt virtually all providers receiving PRF payments would benefit from the latter change. Mr. Parkinson also discussed Congress' failure to replenish the PRF, saying it was necessary to keep the cost of the stimulus portion of the legislation below $1 trillion while still including the $600 individual payments. He feels there will be about $23 billion left in the PRF after the Department of Health and Human Services (HHS) makes all planned distributions. According to the stimulus bill, HHS is to distribute the remaining money based on lost revenue and increased expense for the third and fourth quarters of 2020 and the first quarter of 2021, which particularly benefits states that did not have much COVID-19 until fall.

Other PRF News. Mr. Parkinson said HHS told AHCA/NCAL last week that both the November SNF Quality Incentive Program payment and the second of three planned rounds of payments under the Phase 3 General Distribution should go out by Friday.

Also, as a reminder, please let OHCA know if you applied for Phase 2 funding and have not received it, which typically would apply to assisted living or ID/DD providers because they did not have targeted distributions. If this is the case for you, please supply the following information, as listed by AHCA/NCAL, and they will investigate your case with HHS:

  • Name of facility
  • Addresses of facility
  • TIN
  • State License number
  • Contact name, phone, email
  • Main Phase 2 issue for each facility (i.e., TIN yet to be validated, TIN deemed ineligible, no Phase 2 payment received, or Phase 2 payment was less than 2% of gross revenue related to resident care)

Implementing the Stimulus. After yesterday's signature of the stimulus legislation, two agencies took action today to implement its provisions.

  • First, the Centers for Medicare and Medicaid Services (CMS) confirmed the sequester extension with this notice:

The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31. The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021.  

  • Later, on the state side, the Office of Budget and Management notified providers that they extended the deadline for spending the Coronavirus Relief Fund awards:

President Trump signed a stimulus bill late yesterday which extends the deadline for the Coronavirus Relief Fund (CRF) an additional year. As a result you will be able to use the Provider Relief funding through December 31, 2021. We will update our Provider Relief guidance accordingly once updated guidance is provided by the US Treasury.

As always, please let us know if you have any additional questions.

SNF Testing State Support Opt-In/Opt-Out Survey. The Department of Aging (ODA) released its monthly opt-in/opt-out survey for state support of testing in SNFs, following an earlier survey for assisted living communities. The ODA memo states:

The next opportunity to adjust your facility’s testing option in the state-supported COVID-19 testing program begins today December 28 – January 3, 2021 for the January 18, 2021 through February 12, 2021 testing cycle. If your facility does not intend to change your current testing option, you are not required to complete the Nursing Facility COVID-19 Testing Opt-In/Opt-Out Survey

Facilities may choose to opt-in or opt-out of the state-supported testing program. Facilities opting-in must choose between one of the following testing options: 

  • Option 1 – Rapid antigen only 
  • Option 2 – PCR only 
  • Option 3 – Alternating PRC and antigen  

Note: By choosing state-supported testing, the facility is fully committing to utilize ALL components of the program (applicable to the testing option) which may include: test supplies, test schedule, assigned labs, and courier services. If the facility is not fully committing to utilize ALL components (applicable to the testing option), the facility should opt-out of the state-supported testing program.

Please contact COVIDTesting@age.ohio.gov for additional questions.  

As we reported previously, the new SNF testing guidelines specify that all SNFs now are on a twice-weekly staff testing regimen, plus resident testing every 3-7 days in the event of an outbreak. This change, which took effect immediately December 21, renders the CMS color chart irrelevant for testing, although it still applies to visitation. This week's chart is not out yet.

AHCA/NCAL Update on Monoclonal Antibodies. We recently began reporting developments related to long-term care (especially SNF) access to monoclonal antibody treatments. This story is very much unfolding and was subject of brief discussion on today's AHCA/NCAL call with state affiliates. After the call, the national association provided the following detailed update:

As a follow up to today’s noon Eastern call, we wanted to send you an update on monoclonal antibody treatments. The SPEED portal (or the Special Projects for Equitable and Efficient Distribution) should go live this week to help allocate monoclonal antibodies (mAbs) to priority populations, including nursing homes and assisted living facilities. The public portal distribution locations map is going through the final stages of approval before launching. AHCA/NCAL will provide updates when the site goes live.

Once live, the public portal distribution location map will provide information where providers can obtain the therapeutic mAbs. It will be accessible by clinicians, patients, as well as State leaders. The information displayed will include both bamlanivimab (Eli Lilly mAb) and the combination drugs casirivimab and imdevimab (commonly referred to as Regeneron) recipient locations. The portal will allow for search function to locate the mAbs based on address, zip code, and scrolling features. Contact information for the locations will be provided in the portal.

The mAb is being made available to nursing homes and assisted living principally through two ways:

Steps for connecting long term care facilities with partnering pharmacies using mAb:

  1. Reach out to current pharmacy to see if they are already participating. 
  2. If they are not participating, but are interested, they should email Chad Worz (cworz@ascp.com) and include the name of the individual pharmacy, address, contact person, email address, and request initial allocation based on the pharmacy size.
  3. If the pharmacy is already an Amerisource Bergan customer, they should include their customer ID, or if not a current Amerisource Bergan customer include the pharmacy license number for the location.
  4. HHS will work to expedite a relationship between Amerisource Bergan Specialty and the pharmacy so that they receive product timely.

Ohio COVID-19 Numbers Down. Today's case total was 4,519, about 1,300 fewer than yesterday and a far cry from the 10,000+ cases we were seeing daily a couple weeks ago. While a cautionary note is that weekend reports typically are lower, plus there is potential for post-Christmas and New Year's surges, the numbers do seem to be trending in the right direction. Nonetheless, December's 2,142 COVID-19 deaths is far and away the highest monthly total for the year. December cases and hospitalizations also make up significant proportions of the total for the entire pandemic. The state's test positivity rate, which topped out over 15% earlier in the month, is down to 12.9%.

Anaphylaxis Guidance. The most serious reaction to the COVID-19 vaccine is anaphylaxis, which has been reported very rarely, but it has happened. As a result, a 30-minute observation period after vaccination, instead of the normal 15 minutes, is recommended for anyone who has had a severe allergic reaction to anything. The pharmacies administering vaccinations in the Pharmacy Partnership for Long-Term Care are prepared to respond to anaphylaxis, but it is prudent for the facility also to be ready in that highly unlikely event. Please see, for this purpose, the Centers for Disease Control and Prevention guidance, "Interim Considerations: Preparing for the Potential Management of Anaphylaxis at COVID-19 Vaccination Sites."