Governor Unveils Budget Proposal. Today Governor Mike DeWine and Lieutenant Governor Jon Husted held a special press conference to announce their budget proposal for the State Fiscal Year 2022-2023 biennium. Following the press conference, which focused on the Administration's plans for $1 billion in one-time money, the state released the traditional blue book and three fact sheets. The blue book is limited mostly to appropriation numbers. The fact sheets - "Investing in Ohio's Future: Renewed Communities," "Investing in Ohio's Future: Healthy People," and "Investing in Ohio's Future: Thriving Economy" - provide some information about policy and spending proposals. The Healthy People fact sheet spends considerable space on a "Nursing Home Initiative," described below. Nothing in the fact sheets addresses other long-term services and supports provider types.

This morning, we received a briefing from Directors Stephanie McCloud (Health), Ursel McElroy (Aging), and Maureen Corcoran (Medicaid), along with Bridget Harrison and Scott Partika from the Governor's Office, on the SNF provisions in the budget. This briefing also did not cover budget proposals affecting other providers. In this morning's meeting, the Directors and Governor's Office staff verbally outlined the proposals below. We do not have any further detail about them, pending release of any additional documents or, most importantly, the actual budget bill, which is expected next week.

• Bed buy-back program ($50 million one-time investment).
• Immediate Health Department (ODH) orders to move patients out when there is immediate risk to health and safety.
• Up to 36 months between surveys for the highest performers (this only could apply to licensure).
• Technical assistance program in Department of Aging ($5 million one-time appropriation).
• “Procedural issues" with Special Focus Facility list.
• Certain key facility staff must reside and work in Ohio.  
• Continue existing Medicaid quality incentive (with added money, amount not stated) for the first year of biennium, with a stakeholder process to identify different metrics for the second year.
• Delay of rate rebasing for an unspecified period of time.
• $50 million to compensate providers for reduced Medicaid occupancy during COVID-19.
• Total SNF funding increase stated to be $440 million, although $340 million of this continues the existing quality incentive, so it is not truly new money.
  

The Administration representatives emphasized that they intend to have continuing conversations with us and recognize the budget will morph during the legislative process and because of potential changes in federal funding. OHCA will analyze the Executive Budget as more information becomes available and, of course, will advocate on behalf of all of our members throughout the next five months of the process.

DODD Budget Recommendations. Although they do not appear in the blue book or in the fact sheets released so far, the Department of Developmental Disabilities (DODD) circulated the following bullet points on their portion of the state budget proposal.

• Maintains FY21 Medicaid reimbursement rates for home and community-based services (HCBS) and Intermediate Care Facility (ICF) services.
• Continues investment from the previous budget that doubled funding for Part C Early Intervention to support Ohio’s children and families.
• Satisfies the Ball v DeWine settlement agreement by maintaining funding for 700 state-funded IO waivers as well as continuing to support affordable housing and integrated day and employment services.
• Provides $1M in new funding to bolster the state’s efforts in the use of innovative technology for more Ohioans with developmental disabilities to be more fully integrated into their community and live with greater independence.
• Increases investment in supports for multi-system youth and their families by $10.5M over the biennium.

DODD scheduled a budget briefing for stakeholder associations tomorrow afternoon.

ID/DD Adult Day Group Limits Increased. DODD announced late Friday that ODH amended their order on day services for people with intellectual and developmental disabilities to increase the permissible maximum group size. The new group size is 12, which does not include staff.

In addition to relaxing group sizes, the new order incorporates requirements for social distancing, facial coverings, screening, cohorting, sanitation, and reporting that previously were detailed in DODD guidance. The DODD announcement emphasizes the person-centered team process for determining whether a person should return to day services.

Please review both the order and the DODD message carefully to make sure you are in compliance with all of these requirements.

Finally Two Ohio Counties Turn Green. The latest Centers for Medicare and Medicaid Services (CMS) county positivity ratings for Ohio showed significant progress this week, reflecting the reduced numbers of cases in the community (3,287 reported today). The table has two green counties for the first time in months, Fairfield and Mahoning Counties, both of which now have positivity rates below 5%. In addition, several counties went from red to yellow: Darke, Franklin, Logan, Marion, Ottawa, Seneca, and Williams. These changes mean the following:

• Indoor visitation is required for SNFs in the green and yellow counties immediately, unless the center had new cases in the past 14 days.
• The CMS testing requirement for staff, aside from an outbreak situation, moves to weekly (yellow) or monthly (green). Please remember, though, that CMS guidance specifies that the new frequency is not implemented until two weeks after a change to a lower-frequency color.

Provider Relief Fund Phase 3. We understand a few providers may have received Phase 3 payments from the Department of Health and Human Services (HHS) Provider Relief Fund last week. If you received such a payment, you may wish to check the amount carefully. We are aware of at least one OHCA assisted living member that received a Phase 3 payment that was less a Phase 2 payment that the provider did not get. If you have this same situation, please notify OHCA. We are working with AHCA/NCAL on how to resolve it.

Interesting Perspective on Vaccination. A New York Times article today casts a different light on vaccine effectiveness numbers. In common parlance, and even at the FDA, effectiveness is gauged by the percentage of vaccinated individuals who became infected by the SARS-CoV-2 virus in clinical trials. The article points out that a better measure may consider infections that cause death or hospitalization. Apparently none of the combined 75,000 people vaccinated in the trials of the five vaccines (Pfizer/BioNTech, Moderna, Johnson and Johnson, Novavax, and AstraZeneca) died and only a few were hospitalized, even in areas affected by variant viruses. This way of looking at the data significantly enhances the value of all the vaccines, including those with nominally lower effectiveness rates.

Vaccine Uptake Rate in SNFs. In this week's CDC Morbidity and Mortality Weekly Report, a group of researchers including AHCA/NCAL's Courtney Bishnoi, Urvi Patel, and Dr. David Gifford examine vaccination uptake rates among SNF residents and staff by comparing vaccination data from the Pharmacy Partnership for Long-Term Care with data on facility census from the National Healthcare Safety Network and staff from the Payroll-Based Journal. The article concludes that across the country, the estimated median percentages of residents and staff members taking the vaccine were 77.8% and 37.5%, respectively. Specific state-level estimates were not provided, but maps showed Ohio at 40-59% for residents and under 40% for staff. The data used in the report are through January 17. The report points out four limitations that could result in underestimating vaccine uptake.

February Webinar - Reopening Dining: Are We There Yet? (from AHCA/NCAL). On Thursday, February 11 at 2pm Eastern, AHCA/NCAL will hold a webinar around dining services in long term care. The CMS QSO memo in September discussed guidelines for reopening communities to visitors and communal dining services. As the vaccine is distributed to long term care, residents and staff have long been ready to get back to normal. With the pandemic still in our midst, this session will discuss best practices for dining services, including lessons learned from COVID-19. Speakers include Anna de Jesus, MBA, RDN, President Nutrition Alliance, LLC and Candace S. Johnson, RDN, FAND, Fellow in the Academy of Nutrition and Dietetics and President, CS Johnson and Associates, Inc.