Vaccination Promotional Spot Featuring Larry Nance. OHCA is offering, for member use, a 17-second video from former Cleveland Cavalier and National Basketball Association All-Star Larry Nance, Sr. The video features Mr. Nance affirming that the COVID-19 vaccination was the most important shot he ever took and urging others to follow suit. We recommend pushing this video out via text or email to staff members and families who are still deciding whether to accept vaccination, as well as using it in social media and anywhere else it might be helpful. There is no cost to you to use it.
Human Services Directors Testify on Budget. Today, the House Finance Committee held a marathon budget hearing that began this morning and is still going strong at this writing, close to 10:00 p.m. The agenda for today's hearing was testimony from six state agency directors: Maureen Corcoran (Medicaid), Kimberly Henderson (Job and Family Services), Stephanie McCloud (Health), Ursel McElroy (Aging), Lori Criss (Mental Health and Addiction Services), and Jeff Davis (Developmental Disabilities). The hyperlinks will take you to the written testimony from Directors Corcoran, McCloud, McElroy, and Davis, whose agencies most affect OHCA's membership. Committee members are asking numerous questions, many of which focus on long-term services and supports. The written testimony largely repeats information we previously reported about the Executive Budget, while we continue to wait for the budget legislation itself.
Probably the most significant relevation was in Director Corcoran's testimony. Previously, the Administration said nothing publicly about rate increases for Assisted Living Waiver, PASSPORT, or other Medicaid home and community-based services in the aging sphere. Director Corcoran wrote, "[c]ommunity nursing and aide services in the ODM and ODA-administered waivers will receive a modest 4% increase in rates, as will the assisted living waiver, at a state share cost of $18.3 million and $25.5 million in SFY 22 and 23 respectively." While this portion of her written testimony refers specifically to waiver services, Director Corcoran said in her verbal testimony that the increase applies to all Medicaid-funded nursing and aide services, which would seem to encompass state plan home health care as well. We will investigate what was intended.
In addition, Director McCloud clarified that the proposal to lengthen the time between licensure surveys only applies to residential care facilities (assisted living). She wrote:
Currently, surveys are conducted every 15 months. Facilities that have received no citations during the previous annual survey and no substantiated intervening complaints would be afforded a 30-month survey interval. Implementing the expanded interval would allow facilities to devote less time to administrative survey tasks and more time to resident care and would result in fewer survey-related disruptions for residents.
Federal Stimulus Legislation Marked Up. Also today, US House of Representatives committees began the process of marking up (amending) provisions of the proposed COVID-19 stimulus legislation. One key change in the Energy and Commerce Committee Medicaid markup is an additional 7.35% Federal Medical Assistance Percentage (FMAP) increase on top of the existing 6.2% increase. This added percentage is only for home and community-based services (HCBS). States can use the funding for provider rate increases tied to direct support professional wages and numerous other Medicaid HCBS expenditures (see pages 31-35 of markup) during the period April 1, 2021, to March 31, 2022. The provision applies to both aging and disability services and includes both state plan and waiver HCBS. Another important item, from the Oversight and Reform Committee, is a state and local government relief package that appropriates $195.3 billion for state governments and contains a provision that, unlike the Coronavirus Aid, Relief, and Economic Security (CARES) Act, allows states to use their allocations to make up for COVID-19-related tax revenue decreases, among other things. This funding, if passed, would be very helpful to Ohio's budget.
CMS Issues QSO on ICF/IID Visitation. The Centers for Medicare and Medicaid Services (CMS) released Quality, Safety, and Oversight letter QSO 21-14-ICF/IID & PRTF entitled, “Visitation at Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) and Psychiatric Residential Treatment Facilities (PRTFs) – Coronavirus Disease–2019 (COVID-19)." The QSO gives recommendations and guidance for visitation in ICFs/IID that bear strong resemblance to a previous CMS directive on visitation in SNFs, but it provides a little more flexibility based on the abilities of the people served.
While there are many recommendations, the QSO states a general philosophy: “Additionally, visitation should be person-centered, supportive of quality of life, and considerate of clients’/residents’ physical, mental, and psychosocial well-being. By following a person-centered approach and adhering to these recommended principles, visitation can occur more safely based on this guidance.” This direction is in line with the Department of Developmental Disabilities’ (DODD's) approach to visitation.
The QSO also strongly encourages routine testing of residents and staff in ICFs. Although this is not a mandate from CMS, we will inquire of the state whether they intend to use the QSO as a platform to require testing.
The QSO covers compassionate care visitation and required visitation, again similarly to the SNF guidance, and lists several survey considerations that point surveyors to specific standards under which they should investigate their concerns. ICF/IID providers should review the QSO in detail to determine whether any changes are necessary in their agencies' visitation policies.
Changes to CDC Vaccination Guidance. The Centers for Disease Control and Prevention (CDC) made a number of changes today to its key guidance on COVID-19 vaccination, "Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States." The most significant revision relates to quarantining vaccinated individuals. CDC removed the recommendation for quaratine in the event of COVID-19 exposure for a person who is at least two weeks but not more than three months past their last shot and does not show any symptoms. This guidance is for the general public, and CDC specified that it also applies to health care workers. For patients and residents, however, CDC's position is much more nuanced. Here is the full text of that portion of the guidelines:
As an exception to the above guidance no longer requiring quarantine for fully vaccinated persons, vaccinated inpatients and residents in healthcare settings should continue to quarantine following an exposure to someone with suspected or confirmed COVID-19; outpatients should be cared for using appropriate Transmission-Based Precautions. This exception is due to the unknown vaccine effectiveness in this population, the higher risk of severe disease and death, and challenges with social distancing in healthcare settings. Although not preferred, healthcare facilities could consider waiving quarantine for vaccinated patients and residents as a strategy to mitigate critical issues (e.g., lack of space, staff, or PPE to safely care for exposed patients or residents) when other options are unsuccessful or unavailable. These decisions could be made in consultation with public health officials and infection control experts.
Thus, the ironclad 14-day quarantine guideline for new admissions and readmissions is no longer quite so ironclad, but the exceptions are rather narrow.
CDC also further clarified its restrictions on tuberculosis (TB) testing in conjunction with COVID-19 vaccination. The guidance now specifies that TB testing can be done before or at the same time as vaccination. If the TB testing needs to be conducted after vaccination, it must be at least 28 days later.
EIDC Notices on Imposter Surveyor, Monoclonal Antibodies. The Department of Health circulated the following two notices on the Enhanced Information Dissemination and Collection system (EIDC):
- It has come to our attention that there are individuals posing as ODH surveyors to obtain information from your facility. All health care facility surveyors who enter your building on behalf of ODH and the Centers for Medicare and Medicaid Services will have proper identification, a business card, and will arrange for an entrance conference with a manager. Please remember that surveyors can enter a facility at anytime of day. A surveyor can provide you their manager's name and contact information to confirm who they are.
If you have this happen to you and are able to get any identifiable information on the individual or the vehicle please provide that to Rebecca.Sandholdt@odh.ohio.gov.
To confirm the identity of an ODH surveyor, you can contact the ODH Bureau of Survey and Certification at 614-752-9524.
The link will be available until Monday – February 22, 2021.
If you have any questions, please contact Dorothy Aldridge at: Dorothy.aldridge@ohiohospitals.org
Extension and Expansion of Employee Retention Credit. Late last year, in the Taxpayer Certainty and Disaster Tax Relief Act of 2020, Congress made changes to the Employee Retention Tax Credit created by the CARES Act. The legislation extended the credit, which previously expired at the end of 2020, to cover the first two quarters of 2021, increased the amount of the credit, and significantly eased the requirements to qualify for it. See this Internal Revenue Service release for details.