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December 3, 2020

Governor DeWine on OPHAS, Travel Advisory, Vaccine Distribution. At Governor Mike DeWine's press conference today, he unveiled this week's Ohio Public Health Advisory System (OPHAS) map, which is now up to 8 purple counties, mostly in northeast Ohio: Montgomery, Richland, Medina, Summit, Portage, Stark, and Lake. Only 8 rural counties are orange, the rest (72) are red. For the first time since April, Ohio now is included in the travel advisory of states with 15% or higher positivity.

Governor DeWine said he will hold another press conference tomorrow at which he will spell out the state's COVID-19 vaccine distribution plan. In response to reporters' questions, however, he shared that Ohio expects to receive approximately 98,000 doses of the BioNTech/Pfizer vaccine shortly after it receives an Emergency Use Authorization, followed by additional shipments of both the Pfizer and Moderna vaccines. He also said vaccinations for SNFs and congregate settings will be accomplished primarily through Walgreens and CVS (the Pharmacy Partnership for Long-Term Care). While recommended by the Centers for Disease Control and Prevention (CDC), the Pharmacy Partnership is not mandatory for states.

CDC Quarantine Guidance: Not So Fast. As we reported yesterday, CDC issued new guidance offering options for reducing a quarantine period from the standard 14 days to 10 days or even 7 days under specified circumstances. Unfortunately, other CDC guidelines specific to SNFs (for instance, "Preparing for COVID-19 in Nursing Homes" and "Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19") have not been updated and still list 14 days. Moreover, the Department of Health (ODH) has not adopted the new quarantine guidance and communicated their non-adoption to local health departments. Until this situation is resolved, we do not recommend members implement the new CDC guidance.

Ionization Air Filtration Now Approved Under COVID-19 Indoor Air Quality Assistance Program. As announced previously, the Bureau of Workers Compensation (BWC) is offering $28 million in federal Coronavirus Aid, Relief, and Economic Security (CARES) Act money to reimburse SNFs, assisted living communities, adult day centers in the PASSPORT, Ohio Home Care, or MyCare Ohio waiver programs, and adult day support providers for people with disabilities for inspections, assessments, maintenance, and improvements to indoor heating, ventilation, and air conditioning (HVAC) systems to control the spread of COVID-19.

When the program was announced, many OHCA members reached out to BWC in hopes that ionization air filtration systems would be an qualifying expense. BWC initially indicated that this technology was not an approved expense. OHCA learned that the Ohio Facilities Construction Commission (OFCC) was the government agency that created the list of qualifying expenses. In discussing this issue directly with BWC, it appears OFCC viewed ionization and other ultraviolet light technologies as secondary systems and instead focused on supporting advanced filters and HVAC modifications that would improve overall ventilation and air quality. 

Thankfully, we had the opportunity to educate BWC on the attributes of ionization and are happy to report that while BWC and OFCC do not directly endorse ionization air filtration, it now will become a qualifying expense. Members are encouraged to view the BWC COVID 19 Indoor Air Quality Assistance Program website as early as the close of business tomorrow, Friday, December 4, 2020. At that time, we expect you will find a new application and frequently-asked question document containing information about the expanded list of qualifying expenses. In addition, BWC will host a webinar so operators can speak directly to BWC engineers and industrial hygienists about this program. OHCA wishes to thank BWC and OFCC for understanding that SNFs and assisted living communities truly are committed to combating COVID-19 in all possible ways and for agreeing to approve this state-of-the-art technology.

CMS Infection Preventionist Certificate Not Required. If a surveyor demands or suggests that a SNF's infection preventionist (IP) needs to have a certificate from the Centers for Medicare and Medicaid Services (CMS) indicating that the IP completed CMS's infection preventionist training, it is not true. While CMS, through CDC, offers a free, online IP training program, there are many other options to meet the regulatory requirements, for instance AHCA's online IPCO course and an in-person program called "NIPPing Infections in the Bud" that OHCA offered at one time. The regulations simply require that the IP complete "specialized training in infection prevention and control," not any specific program.

"Show Me the Regulation Requiring That." Speaking of surveyor dictates, we recommend any time you feel a surveyor's expectations may not be valid, politely ask them to show you where in the regulations the specific requirement exists. If the surveyor provides you with a reference but you have questions about how it is being interpreted or if the surveyor does not provide a reference but continues to insist on the requirement, please feel free to reach out to OHCA for assistance.

Antigen Test Tomorrow. Dr. John Weigand of Post-Acute Regional Rapid Testing (PARRT) fame suggests that since a week has passed after Thanksgiving, it is a good time to do a point-of-care antigen test (if available) on any residents who had a Thanksgiving leave of absence. If they were exposed on Thanksgiving, the virus has had sufficient time to manifest itself on an antigen test.