Long-Term Care Cases, Deaths Drop Again. This week's Department of Health (ODH) dashboard showed 600 fewer combined resident and staff COVID-19 cases in long-term care facilities (assisted living, ICFs/IID, SNFs) than last week. COVID-19-related deaths also fell by 18. The case numbers are the lowest since the week of October 21, when the massive surge of infections began. Governor Mike DeWine, in today's remarks, spotlighted the reduced long-term care cases and attributed the decline to vaccinations, which began at almost the exact moment when cases peaked in December. While vaccinations undoubtedly have had a major impact, the lower rates in long-term care are shadowing the experience in the general population. Today's statewide daily case report was 2,806, well below the three-week average of 3,892. Hospitalizations also are down, leading the Governor to lift the curfew that has been in effect since November 19. The state, on the other hand, recognized approximately 650 additional COVID-19 deaths that apparently were not counted in November and December. None of these showed up in the long-term care numbers, though. In contrast to the reduced case numbers, the Ohio Public Health Advisory System still shows all but the same four southeast Ohio counties as red.

CDC Guidance on Ongoing Vaccine Access. The Centers for Disease Control and Prevention (CDC) published guidance entitled, "Ensuring Access to COVID-19 Vaccine in Long-Term Care Facilities." The guidance addresses the hot topic of obtaining vaccinations after the Pharmacy Partnership for Long-Term Care ends. CDC posits three options for facilities:

• Work with a long-term care pharmacy that is enrolled as a state vaccine provider. These pharmacies will receive vaccine allocations from the state. As we reported in Tuesday's COVID-19 Update, Ohio is moving in this direction, but the enrolled long-term care pharmacies have not yet received vaccine.
  
• Work with a long-term care pharmacy that is enrolled as a vaccine provider in the Federal Retail Pharmacy Program. Starting today, these pharmacies will receive direct federal allocations of vaccine.
  
• Enroll as a vaccine provider with the state. The state would have to determine whether to allocate vaccine to facilities that are enrolled, as some already are.

Commenting on the guidance, AHCA/NCAL wrote:

Please note that facility staff cannot administer the vaccine on behalf of the pharmacy unless the facility themselves are enrolled as a vaccine provider with their state. However, LTC pharmacies participating in the Federal Retail Pharmacy Program are allowed to subcontract staff for vaccine administration, which could include facility staff.

We would add that Ohio likely will allow subcontracting, as agreed by the pharmacy and the facility, under the state vaccine provider program.

AHCA/NCAL Assistance with Provider Relief Fund Issues. AHCA/NCAL would like to help members who have unresolved Provider Relief Fund issues, including with the SNF Quality Incentive Program. If you have a remaining issue, please fill out this brief survey by Friday, February 26, 2021. AHCA/NCAL will work with Congress and the Biden Administration to resolve these problems. Of course there is no guarantee of funding, but AHCA/NCAL will bring the issues to the attention of the appropriate officials. Please contact AHCA/NCAL’s Senior Director of Non-Profit and Constituent Services, Dana Ritchie, at dritchie@ahca.org with any questions. 

ODM Disallows SNF Billing for COVID-19 Services. Today, responding to questions from OHCA, Cheryl Guyman of the Department of Medicaid (ODM) addressed whether SNFs can bill Medicaid for administering COVID-19 point-of-care tests, vaccinations, and monoclonal antibody (mAb) infusions. Ms. Guyman said only laboratories and pharmacies can bill for testing. For vaccinations and mAbs, any eligible provider can bill, but ODM does not consider SNFs eligible because in their view, administration of vaccinations and mAbs is covered by the SNF per diem. OHCA pushed back vigorously, particularly relative to mAbs, because the Centers for Medicare and Medicaid Services (CMS) recommends Medicaid programs pay for administration and because mAbs are a life-saving treatment that requires considerable staff time to administer. Ms. Guyman indicated that ODM would reconsider the issue.

Budget Bill Draft Available. For any members interested in perusing a 2,057-page piece of legislation, a draft of the Executive Budget bill was posted today on the House Finance Committee website for download. The bill has not yet been introduced (we understand that will occur next Tuesday) and does not bear a bill number. OHCA is in the process of analyzing the draft legislation. It provides additional detail on such proposals as the state's SNF bed buy-back and quality incentive programs, ODH's request for authority to issue orders against facilities, the Department of Developmental Disabilities' plan to roll back ICF/IID rates, and much more.

AHCA/NCAL Discusses Vaccinations and COVID-19 Restrictions. In a blog post today, AHCA/NCAL addressed the question at the front of everyone's mind: when can the restrictions COVID-19 has placed on long-term care residents and providers be lifted, now that so many people are being vaccinated. The association explained, specific to visitation restrictions:

Through clinical trials, these vaccines have been proven to be extremely effective at preventing illness caused by COVID-19, but we do not yet know whether individuals who are vaccinated can still contract COVID-19 (without symptoms) and spread it to others. So, if a vaccinated visitor enters the facility, it’s possible they could spread COVID-19 to others. This is why CMS and the CDC are hesitant to modify guidance at this time.

AHCA/NCAL added that they penned a letter to the new CDC Director asking for research into the degree to which vaccinations prevent COVID-19 spread in congregate settings and proffering the association's own findings.

Project ECHO Outpatient Therapeutics Mini-Series. OHCA is working with Project ECHO to deliver COVID-19 education to Ohio SNFs, but Project ECHO has many other initiatives world-wide, some of which also pertain to COVID-19. One of these is their Outpatient Therapeutics Mini-Series, which covers mAbs and other COVID-19 therapeutics. The mini-series provides key information to facilitate use of these therapies, including an extensive resource library with sample administration procedures, physician orders, care plan, checklist, and flowsheets, among other materials.  

Contract Provider Test Record Retention. In addition to staff, SNFs must ensure that contracted health care personnel and vendors who enter the center are tested in accordance with the center's staff testing frequency. This is required by CMS under Quality, Safety, and Oversight letter 20-38-NH. Recently, OHCA asked ODH how long documentation of testing should be maintained. ODH's Jill Shonk responded:

From a regulatory perspective we do not have a specific rule or regulation that specifies. However, if a facility disposes of information and needs evidence during an investigation to show what was completed, they will not have the evidence. They may also need to think about their policies and procedures on medical records retention. This would be considered a “lab” test and should be part of the medical record.