Meeting the needs of Ohio’s
Long-term Care Professionals since 1946

Find a Care Provider
MEMBER LOGIN  |  CONTACT
|  Follow OHCA on Facebook Follow OHCA on Twitter Follow OHCA on Instagram Follow OHCA on Linkedin

 

December 30, 2020


Monoclonal Antibody Access Update. Last week in one of our COVID Updates, we provided a list of long-term care pharmacies that are reportedly part of a Centers for Disease Control and Prevention (CDC)/Department of Health and Human Services (HHS)-led distribution effort for monoclonal antibody (mAb) treatments. We heard from many of those pharmacies that they received a limited number of doses. 

Additionally, we understand that other long-term care pharmacies not on the list were able to obtain mAbs from Eli Lilly and Regeneron. We encourage members interested in utilizing mAb treatments to reach out to their long-term care pharmacy partners to see if they have or can obtain treatments for staff or residents who have mild or moderate COVID-19. 

For your medical director to learn more about the potential benefits of mAb treatments in long-term care, please see the following information from AMDA - The Society for Post-Acute and Long-Term Care Medicine and the Centers for Medicare and Medicaid Services (CMS):

Vaccinating People Who Have Recovered from COVID-19. This question usually takes the form of whether a person who had COVID-19 in the past and recovered still should be vaccinated. The consensus answer is yes, because vaccination provides stronger and longer immunity than a COVID-19 infection. Assuming the person who had COVID-19 agrees to be vaccinated, the next question is how long after recovering they should wait before receiving the first shot. The conventional answer is 14 days, but CDC guidance is slightly different. In CDC's "Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States," which was updated most recently today, CDC writes:

Vaccination of persons with known current SARS-CoV-2 infection should be deferred until the person has recovered from the acute illness (if the person had symptoms) and criteria have been met for them to discontinue isolation. This recommendation applies to persons who develop SARS-CoV-2 infection before receiving any vaccine doses as well as those who develop SARS-CoV-2 infection after the first dose but before receipt of the second dose. While there is otherwise no recommended minimum interval between infection and vaccination, current evidence suggests that reinfection is uncommon in the 90 days after initial infection. Thus, persons with documented acute SARS-CoV-2 infection in the preceding 90 days may delay vaccination until near the end of this period, if desired.

Boiling down this paragraph, a recovered COVID-19-positive individual should wait until they meet the criteria for discontinuing isolation (10 days after symptom onset and 24 hours fever-free or 10 days after a positive test without symptoms) but can choose to wait 90 days. Obviously in many cases, a 90-day wait would put the person outside of the Pharmacy Partnership for Long-Term vaccination clinic schedule and, therefore, would not be advisable.

Today's updates to the CDC clinical guidelines cover several other topics, including specifying that if a person experiences even a relatively minor allergic reaction to the first dose of a COVID-19 vaccine, they should not get the second dose. The clinical guidelines are well worth reviewing for anyone wishing to gain a better understanding of the vaccines.

Key Provider Relief Fund Provision in Stimulus Bill and Update on Single Audit. This article is an edited version of a piece by AHCA/NCAL's Mike Cheek. The enacted omnibus legislation (Consolidated Appropriations Act, 2021) offers very helpful guidance to HHS regarding the definitions of revenue, health care-related expenses, and lost revenue. Specifically, the legislation directs HHS to allow providers to use the June 2020 version of its Provider Relief Fund (PRF) frequently-asked questions (FAQs): 

That, for any reimbursement from the Provider Relief Fund to an eligible health care provider for health care related expenses or lost revenues that are attributable to coronavirus (including reimbursements made before the date of the enactment of this Act), such provider may calculate such lost revenues using the Frequently Asked Questions guidance released by the Department of Health and Human Services in June 2020, including the difference between such provider’s budgeted and actual revenue budget if such budget had been established and approved prior to March 27, 2020.

Going back to the June guidance was one of AHCA/NCAL's top asks. Of note, there are two sets of June FAQs. While both are helpful, the June 29 version is particularly useful and appears to be the version intended by Congress, providing for instance:

You may use any reasonable method of estimating the revenue during March and April 2020 compared to the same period had COVID-19 not appeared. For example, if you have a budget prepared without taking into account the impact of COVID-19, the estimated lost revenue could be the difference between your budgeted revenue and actual revenue. It would also be reasonable to compare the revenues to the same period last year.

To date, HHS has not changed the deadline for the first PRF report: February 15, 2021. We believe HHS will need to push this date out. As we learn more, we’ll be sure to alert you.

Relative to the single audit requirements, the Compliance Supplement Addendum would keep PRF funding out of the single audits until years ending December 31, 2020, and later. You can read more about that and the rest of the addendum in the American Institute of Certified Public Accountants alert located here: GAQC Alert #419. The Office of Management and Budget wants to link the amounts reported on the schedule of expenditures that are audited as part of the single audit to the direct reporting to HHS.

The major certified public accountant (CPA) associations have communicated with HHS directly about their concerns with the timing of the federal reporting requirements (very tardy), as well as the need for more detailed audit guidance from HHS for for-profit health care entities, especially the non-single audit option (financial audit under Generally Accepted Governmental Auditing Standards) permitted by their regulations. 

AHCA/NCAL will work with the major CPA associations and other health care provider groups to secure clarification on HHS’s approach to the omnibus language as well as engaging with the incoming administration’s PRF team. If you have questions, suggestions, or concerns, including ideas for tools and resources, please contact us at covid19@ahca.org.

FFCRA Paid Leave Not Extended in Relief Package. The Families First Coronavirus Relief Act (FFCRA) paid leave provisions, which applied to employers with fewer than 500 employees, were not part of the extended and expanded benefits included in the omnibus pandemic relief and government funding package signed by President Donald Trump earlier this week (the Consolidated Appropriations Act, 2021). This means covered employers no longer are required to provide paid leave under FFCRA after December 31, 2020. Nonetheless, the legislation extended the FFCRA tax credit, which reimburses employers for the cost of providing the paid leave, through March 31, 2021. If employers voluntarily provide the FFCRA leave payments through that date, they still can qualify for the tax credit if they did not claim it for the same employee in 2020, depending on the circumstances. For more information, please see this article in the National Law Review.

SNF Immediate Jeopardy Citations During Pandemic. OHCA compiled and analyzed immediate jeopardy (IJ) citations for SNFs surveyed during the second and third quarters of calendar year 2020, when the COVID-19 pandemic was in full swing and all surveys either were complaint or Focused Infection Control surveys (FICs). ODH indicated recently that they do not intend to restart annuals for SNFs or ICFs/IID until Ohio reaches reopening phase 3, which is not likely to occur anytime soon.

During the second quarter, ODH issued six IJ citations in five facilities during five surveys. These numbers jumped to twenty-seven IJ citations in twenty-three facilities during the same number of surveys. The significant increase in IJs corresponds to ODH's resumption of more complaint investigations and clear toughening of FICs, based on CMS direction. Between the two quarters, ODH issued 16 J-Level, 4 K-Level, and 15 L-Level deficiencies. The proportion of L-level cites is a break from the past. There were a total of 6 citations with associated deaths. The tags cited as IJ included:

  • F880 (Infection Control & Prevention) - 12
  • F689 (Accident Hazards/Supervision/) - 9
  • F600 (Abuse) - 6
  • F583 (Personal Privacy/Confidentiality of Records) -2
  • F695 (Respiratory/Tracheostomy Care) - 1
  • F725 (Sufficient Nurse Staffing) - 1

For additional details, please see our Immediate Jeopardy Bulletins for the second and third quarters.

Behavioral Health Providers as Essential Health Care Workers. A well-known provision of CMS Quality, Safety, and Oversight letter (QSO) 20-39-NH addresses entry into SNFs by personnel commonly called essential health care workers. A similar provision appears in the Department of Health (ODH) fifth amended visitation order, under the term, "personnel necessary to the operation of homes." CMS stated in the QSO:

Health care workers who are not employees of the facility but provide direct care to the facility’s residents, such as hospice workers, Emergency Medical Services (EMS) personnel, dialysis technicians, laboratory technicians, radiology technicians, social workers, clergy etc., must be permitted to come into the facility as long as they are not subject to a work exclusion due to an exposure to COVID-19 or show signs or symptoms of COVID-19 after being screened. We note that EMS personnel do not need to be screened so they can attend to an emergency without delay. We remind facilities that all staff, including individuals providing services under arrangement as well as volunteers, should adhere to the core principles of COVID-19 infection prevention and must comply with COVID-19 testing requirements.

While mental health and substance abuse professionals are not specifically listed in the QSO, it is clear that they "provide direct care to the facility's residents" and perform a function similar to others who are listed specifically. CMS did not make the list exclusive, but intended that others not listed (therapists would be another obvious example) who provide direct care should be allowed entry, subject to screening and testing standards. Behavioral health providers also would be appropriate ancillary personnel to include in SNFs' vaccination clinics, as discussed in last night's COVID-19 Update.