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December 29, 2020


BWC Indoor Air Quality Assistance Program Extended Through June 30, 2021. As announced in early December, the Bureau of Workers Compensation (BWC) is offering $28 million in federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funding to reimburse SNFs, assisted living communities, and adult day center and support providers up to $15,000 per location for inspection, assessment, maintenance, and improvement of indoor heating, ventilation, and air conditioning (HVAC) systems to control the spread of the COVID-19. While the original deadline for the program was December 30, 2020, BWC informed OHCA today that because of the federal Consolidated Appropriations Act, they now will accept applications through June 30, 2021, or until the funds are exhausted, whichever comes first. We highly encourage members to visit the BWC COVID 19 Indoor Air Quality Assistance Program website for more information about this beneficial program. While regular maintenance and filtration are eligible expenses through this program, so are secondary systems like ionization air filtration systems. As of late last week, BWC had allocated less than $1 million of the $28 million, so members should learn more and if eligible, apply. In addition, now that the deadline is extended, OHCA will advocate for ICFs/IID and inpatient hospice facilities to be included in this opportunity.

AHCA/NCAL Vaccine "Fireside Chat" Tomorrow. AHCA/NCAL will hold what they call a fireside chat at 4:00 p.m. tomorrow, December 30, featuring Dr. David Gifford and physicians from CMS and the Centers for Disease Control and Prevention (CDC). The conversation will address myths about the COVID-19 vaccines. You may register using this link. Apparently questions will not be taken during the call, but can be submitted in advance to covid-19@cms.hhs.gov.

Governor DeWine Signs SB 310. Today, Governor Mike DeWine signed Senate Bill (SB) 310, which passed the General Assembly as an emergency measure on December 18. Somewhat of a COVID-19 Christmas tree as well as the state's capital budget, SB 310 adjusted the Department of Developmental Disabilities' spending authority to accommodate another one-time Medicaid payment to DD waiver providers that will amount to $77 million. The next step in securing this funding is for the state to apply to the Centers for Medicare and Medicaid Services (CMS) to revise Ohio's Appendix K submission, which allows emergency changes to home and community-based services waivers.

Assisted Living COVID-19 Testing Survey. We heard a few assisted living members were not given the option to select antigen testing in the latest opt-in/opt-out survey from the Department of Aging (ODA) even though they have Clinical Laboratory Improvement Amendments (CLIA) Certificates of Waiver. The ability to make that selection, according to Director Ursel McElroy, is based on a list of waived settings ODA received from the Department of Health and Human Services (HHS). There appear to be some issues with the accuracy of the list. It also would not include providers who applied for but have not yet received a Certificate of Waiver. Under recent CMS guidance, these providers may perform antigen tests before receiving their certificate. While we will pursue with ODA allowing the omitted providers access to antigen testing, the opt-in/opt-out survey is due December 31. We recommend completing the survey and requesting four rounds of polymerase chain reaction (PCR) tests, plus notifying OHCA of the situation. We will try to get two of the PCR rounds swapped out for antigen tests.

CMS Positivity Ratings Improve Slightly, But No Impact on SNF Testing. This week's CMS county-level positivity data for Ohio show a slight improvement from last week, as 30 counties now are yellow, although most of them still have positivity percentages above 10%. Unfortunately, though, the yellow ratings do not mean that SNFs in those 30 counties can move to weekly testing because state guidelines mandate twice-weekly testing of SNF staff in all Ohio counties. Yellow status does allow a SNF to offer indoor visitation, so long as it has not had an outbreak for at least 14 days.

There is some confusion over state support and the opt-in/opt-out survey for SNFs, which is open until Sunday, January 3. The survey presents four options for state support of staff testing under the twice-weekly frequency shown in the state's schedule: 1) 6 rounds of BinaxNOW antigen testing cards and 2 rounds of PCR tests; 2) 4 rounds of BinaxNOW; 3) 4 rounds of PCR; 4) no state support. If a provider wants state support but antigen tests only, they should select option 2 and procure the other 4 rounds of antigen tests on their own. If a provider wants state support but PCR tests only, they should select option 3 and work with a lab of their choice for the other 4 PCR rounds. According to the guidelines, ODA will subtract the number of BinaxNOW cards HHS supplies to the facility from the allocation under options 1 or 2, but we hear anecdotally this may not always happen.

Vaccination Reporting. Today the Department of Health (ODH) circulated the latest Ohio Vaccine Preparedness Office Weekly Update via the Enhanced Information Dissemination and Collection system (EIDC). Along with other information, ODH addressed vaccination reporting in a message about not wasting vaccine:

  • Don’t let unused COVID-19 vaccine go to waste - When faced with the possibility that a vial of vaccine will be wasted because no one from the priority group is present for vaccination, such as at the end of a vaccination clinic or session when the remaining vial must be either used or discarded, the CDC has clarified that no vaccine should ever be wasted. If you administer vaccinations under these circumstances: 
    • The vaccine administration must be reported in ImpactSIIS, including race and ethnicity data, within 24 hours.
    • Target population/occupation data does NOT need to be reported for vaccinated individuals who are not in a Phase 1A priority population.
    • The provider must include these vaccinated individuals in follow-up plans for administering second doses.

Please note that this direction, including the portion about reporting vaccine adminstration, is intended for vaccine providers - entities that administer the vaccine, not long-term care providers. In the Pharmacy Partnership for Long-Term Care, the provider is the pharmacy, which must do the reporting. At some time in the future, long-term services and supports providers may begin administering vaccine and then would need to report. As for ODH's comments about wasting, we recommend including as many ancillary personnel as possible in vaccinations: home health and hospice staff, transport workers, medical directors, nurse practitioners and consultants, therapists, podiatrists, hairdressers - anyone who could have contact with residents. Members say the pharmacies have no concerns about vaccinating these individuals.

Also on reporting, AHCA/NCAL supplied the following information about voluntary vaccination reporting to the National Healthcare Safety Network:

The National Healthcare Safety Network (NHSN) has launched the COVID-19 Vaccine Reporting Modules for residents and healthcare personnel in long term care facilities (LTCFs). These new reporting modules are optional and require only Level 1 SAMS security clearance, which is the same security clearance required to upload data to the COVID-19 LTCFs module.   
 
The COVID-19 Vaccine Modules can be accessed here. There are training slides available to help LTCFs who choose to upload COVID-19 Vaccine data to this module. COVID-19 Data Collection forms and full Table of Instructions for each form can be found on the Surveillance for Weekly HCP and Resident COVID-19 Vaccination webpage.

Additional Provider Relief Fund Clarifications. HHS added several items, dated 12/28/2020, to its frequently-asked questions on the Provider Relief Fund (PRF). The three most noteworthy items are as follows:

  • My state or territorial Medicaid or Children’s Health Insurance Program (CHIP) agency has directed providers to use Provider Relief Fund dollars before applying Medicaid or CHIP reimbursement, as well as Medicaid COVID-19 supplemental payments, to cover health care-related expenses or lost revenues attributable to coronavirus. Is this permissible? (Added 12/28/2020)

No. As it relates to expenses, providers identify their health care-related expenses, and then apply any amounts received through other sources (e.g., direct patient billing, commercial insurance, Medicare/Medicaid/CHIP, reimbursement from the Provider Relief Fund COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured, or funds received from FEMA or SBA/Department of Treasury’s Paycheck Protection Program) that offset the health care-related expenses. Provider Relief Fund payments may be applied to the remaining expenses or cost, after netting the other funds received or obligated to be received which offset those expenses.

  • What will be the methodology/formula used to calculate provider payment in Phase 3? (Modified 12/28/2020)

Providers will be paid up to 88 percent of their reported losses and net change in their operating expenses from patient care from the first half of 2020. Some applicants will not receive an additional payment either because they experienced no change in revenues or net expenses attributable to COVID-19, or because they have already received funds that equal or exceed reimbursement of 88 percent of reported losses. Providers that have not yet received and kept a payment that is approximately 2% of annual revenue from patient care as part of the General Distribution will receive at least that amount as part of their Phase 3 payment.

  • How is the infection gateway calculated for determining eligibility for Quality Incentive Program payments under the Nursing Home Infection Control Distribution? (Added 12/28/2020)

The infection gateway criterion specifically excludes facilities that are found to have an infection rate exceeding the estimated infection rate in their county during the performance period. County infection rates are measured using daily COVID-19 community profile reports (CPRs) disseminated under the HHS Protect data program. CPRs contain information on the rate of COVID-19 infections for all residents in each county. County infection rates are not the same as county positivity rates.

NHSN Data Upload Issues Reported (from AHCA/NCAL). The National Health Care Safety Network (NHSN) has reported that there is an error occurring with data upload to the NHSN Long Term Care Facility modules. This has to do with an incorrect auto-populated date error. The CDC is urgently working to correct the NHSN application error that is impacting reporting COVID-19 data since December 26, 2020. 

When entering weekly COVID-19 data for the week of December 21-27, the pre-populated date for the week indicates that the week ends on December 27, 2021, instead of December 27, 2020. When trying to save data, the system generates an error message and will not allow facilities to save their data.

A solution will be deployed in the NHSN application later this week, but until then a work-around can be used to continue reporting COVID-19 vaccination data.  

The CDC has offered the following steps for the work-around:  

  1. On the weekly vaccination data entry screen, toggle the calendar to its previous month (November 2020) using the left-facing arrow.  
  2. After the month of November 2020 appears, toggle the calendar back to December 2020 using the right-facing arrow.  
  3. You should now be able to enter data for the week ending December 27, 2020.