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December 8, 2020

SNF QIP Facility-Specific Payments. In a break from past practice, the Department of Health and Human Services (HHS) released, in advance of the payments that should start to come tomorrow, a spreadsheet showing how much each eligible SNF will be paid for the October installment of the Provider Relief Fund Quality Incentive Payment (QIP). Please see this table for the amounts for eligible Ohio facilities. The table also shows the facility and county infection rates, infection performance score, and mortality adjustment for each center, leading to the payment amount. As we reported yesterday, 594 Ohio SNFs qualified for payments totaling $27.5 million, or an average of $46,000 each.

Giff's Vaccine Update. AHCA/NCAL's Dr. David (Giff) Gifford just provided an update on several frequently-asked questions about the current vaccination program for long-term care and the vaccines themselves. Here are his comments:

  1. Walgreens: They are still sending out information and should be done by tomorrow night. We are still waiting for contact information for providers to contact them if they have not heard. We have said this is really needed as anxiety is rapidly increasing. They are still updating some material before they post on their website.
  2. CVS: CVS has already started to send their initial emails to matched facilities. They are also initiating live phone calls to facilities, so each facility should receive a phone call in the coming days. In the meantime, please update your contact information here: It’s critical that each facility supply updated contact information (for primary and secondary points of contact for each facility). Second, please visit their website here: By clicking onto the ‘COVID-19 Introductory Email Communication,’ you can see the initial email that was distributed.
  3. SNFs or AL who did not enroll or pick CVS or WAG as a backup: they must contact their state health department to find out how or when they can get access to the vaccine. They should NOT contact CVS or WAG.
  4. Physician orders: Physician orders for the vaccine are NOT required. We have confirmed that neither WAG nor CVS will require a physician order. Also, the HHS secretary used his authority under the Prep Act to override all state and local laws to allow Pharmacist to order and administer the vaccine. “…as an Authority Having Jurisdiction under the Secretary’s March 10, 2020 declaration under the Public Readiness and Emergency Preparedness Act (PREP Act), the Office of the Assistant Secretary for Health (OASH) issues this guidance. Subject to satisfaction of the requirements listed below, this guidance authorizes State-licensed pharmacists to order and administer, and State-licensed or registered pharmacy interns acting under the supervision of the qualified pharmacist to administer, to persons ages three or older COVID-19 vaccinations that have been authorized or licensed by the Food and Drug Administration (FDA).” (see
  5. Staff Incentives: Are Financial and other incentives ok (e.g gift cards, bonuses, etc) to use with staff to encourage uptake of the vaccine. We confirmed with CMS that they have not issued any restrictions to encourage staff to receive the vaccine.
  6. Promotional material. We met with CDC team today and they are working on a tool kit for LTC that should be out the end of this week or early next week. AHCA is also developing some material  and will use the FDA Pfizer data released today (see next item).
  7. FDA EUA review. The Pfizer background material was released today (attached for those geeks) and shows the vaccine is very effective including in elderly over the age of 65 and age over 75 and in minority populations. Just over 4% of the participants were over age of 75. Vaccine efficacy was equivalent in those under 55 and those over 55. The side effects look predictable for a person’s immune response. For those under 55 in age: Reaction at inject site (redness, soreness or swelling) rounding numbers to nearest 5% increments (75% vs 10% vaccine vs placebo); systemic symptoms (fever, headache, aches) were 60 vs 50% after first injection and 70% vs 40% vaccine vs placebo). Reactions leading to serious adverse events, death or withdrawal from the study were the same (<1% vs 1% vaccine vs placebo). Fever was about 7% vs 2% after dose 1 and 30% vs 1% after dose 2; GI symptoms were the same in both groups. This appears to be very safe vaccine with predictable reactions to a vaccine stimulating the immune response to make antibodies. The pattern was nearly identical in elderly over the age 55 but the actual rates were slightly different. There were 6 deaths in the trial: 2 in vaccine and 4 in placebo.

Pharmerica (Walgreens) Vaccine Webinar. As Omnicare (CVS) did yesterday, Pharmerica held a webinar today on its plans for vaccinating long-term care residents and staff under the Pharmacy Partnership for Long-Term Care. A recording of the webinar is available here, and the slides here (Powerpoint download). Unlike the CVS presentation, which focused much more on the vaccine distribution process - preparing for and delivering the vaccination clinics - the Pharmerica webinar was more about the vaccines themselves and their development and review.

25,000 COVID-19 Cases Added Today. The state reported a staggering 25,721 new COVID-19 cases today, although more than 12,000 of these were results from antigen test results done since November 1 that previously were not counted. The total number of cases since the pandemic began is now more than 500,000, or one in every 23 Ohioans. The state reported an additional 81 deaths from COVID-19, raising the monthly total to 674 so far and 7,103 since the beginning. The antigen test results were added en masse because the state abandoned its practice of confirming antigen results based on symptoms or exposure.

CareStart Rapid Tests Available to HHAs, Hospices, and other CLIA-Waived Providers. With Abbott BinaxNOW tests still not available for purchase, many of our home health and hospice agency members are looking for affordable rapid testing options. McKesson obtained a supply of another rapid test called CareStart that costs less than $25 and is available for delivery in about one week. The test has 88% sensitivity and 100% specificity. Agencies must have a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver to perform the tests. They read similarly to a pregnancy test.  Results are generated in about 10-15 minutes. For more information on the CareStart test, please click here. For ordering information please contact Jeff Mazer at McKesson. Don’t delay, tests are in high demand!

DODD Extends OTS Reporting Deadline. The Department of Developmental Disabilities (DODD) announced that it is extending the deadline for Outcome Tracking System (OTS) reporting until June 30, 2021. All data that would normally be due in March will need to be entered in OTS by June 30, 2021.

DODD Recorded Pulse Oximetry Webinar. DODD held a webinar on December 2, 2020, to explain to DD providers how properly to use a pulse oximeter. The department understands that many interested parties were not able to attend the webinar and provided a link to the recording.

Reminder: AHCA/NCAL Occupational Safety and Health Administration (OSHA) Resources.