SNF Testing Controversy. We continue to receive member questions about required SNF COVID-19 testing frequency, especially with widespread vaccination of residents and staff. On December 21, 2020, the state, through the Department of Aging (ODA), changed the SNF testing guidelines to require all SNFs in Ohio to test staff members twice a week regardless of the Centers for Medicare and Medicaid Services (CMS) positivity-based county colors. That guidance emerged just as the COVID-19 surge reached its peak in both the general public and congregate care settings and at the very beginning of the vaccination program. Two weeks later, Health Department (ODH) officials announced in a meeting with provider associations that they would not enforce the state guidelines via the survey process, only the CMS requirements. ODH pointed out that there is a separate mechanism for enforcing Director Health orders such as the one requiring compliance with the state testing guidelines.

Throughout January, the COVID-19 surge receded, and more Ohio counties turned yellow or, just this week, green, which allows less frequent testing than the state guidelines require. This situation added to members' confusion about which testing regimen to follow.

In this month's meeting with ODH, the discussion turned to whether ODA would revise the guidelines to be consistent with the CMS directive. ODA's Meredith Philabaum indicated that ODA has no near-term plans to do so, leaving the conflict in place. She added that ODA will issue a new testing schedule by the end of this week that retains the twice-weekly frequency.

This means SNFs will have to decide for themselves what to do. If they choose to reduce testing per the federal guidance, they are not at risk of survey citations, but they would be out of compliance with the state order. The enforcement mechanism for Director's orders is for the Attorney General or a local prosecutor to prosecute the violator for a criminal offense under section 3701.99 of the Revised Code. No facility has been, and likely never will be, prosecuted for testing facility staff at a different frequency than the state guidelines prescribe, but the sanction does exist.

Other ODH Interpretations. At the same meeting, ODH survey and Bureau of Infectious Disease (BID) staff provided several other interpretations, as follows.

• When ODH conducts a Focused Infection Control survey, CMS currently expects surveyors to address backlogged complaints going back as far as the spring of 2020, although ODH has some discretion on how many allegations they will investigate. Rebecca Sandholdt said ODH is seeking relief from the requirement to investigate old complaints.
• Surveyors are tested for COVID-19 weekly and are receiving vaccinations if they so choose.
• Jil Shonk said if the enforcement bureau requests a plan of correction from a residential care facility (RCF), they expect the plan to cover any past violations that have not been put back in compliance through an annual survey.
• Amanda Smith of BID said that they do not decide whether to reduce restrictions applicable to RCFs as more residents and staff get vaccinated.
• Ms. Smith said best practice is to screen even vaccinated RCF residents for symptoms twice a day, but once is the minimum standard.
• Heather Coglianese said the 6th amended visitation order's provisions on compassionate care visits are meant to be interpreted broadly to allow compassionate care visits in as many situations as possible.
• Ms. Smith said ODH follows the latest Centers for Disease Control and Prevention (CDC) guidance on antigen testing and, in particular, the recommendation against moving a patient with an unconfirmed positive antigen test into a COVID-19 unit.
• State support for outbreak testing of residents is set at the maximum allowable interval (7 days).
• Rick Hoover repeated guidance OHCA published earlier about the State Fire Marshal's treatment of temporary walls for COVID-19 units. They will issue a non-punitive notation so it is on record to be checked after the pandemic. Such a notation should not delay RCF license renewal.

Ohio is among the top five states for delivering COVID-19 vaccine doses to long-term care facility residents. As a result of this aggressive effort to vaccinate those in long-term care, Ohio is beginning to see a drop in cases.

Pfizer has notified Ohio that they believe they will increase their shipment of vaccine by 40 percent around mid-to-late February. Shipments could additionally increase even more by the end of March. Pfizer is currently shipping approximately 73,000 doses to Ohio per week.

Moderna doses have increased from 73,200 two weeks ago to 105,600 doses that are expected next week. 

Ohio was one of the first states to draw unused doses from the long-term care program, and those 77,000 extra doses are being delivered this week to select CVS and Walgreens pharmacies.

AHCA/NCAL Finds Vaccination Reduces COVID-19 Spread in SNFs. Today AHCA/NCAL published a lengthy release that discusses the significant reduction of COVID-19 cases and deaths in long-term care facilities, along with advocating for additional appropriations to the Provider Relief Fund to support the continued fight against the pandemic. The release examines the impact of lower community spread and vaccination of facility residents and staff on this trend. With respect to vaccination, AHCA/NCAL wrote:

Johnson & Johnson Files for EUA. Johnson & Johnson announced that it filed paperwork for an Emergency Use Authorization (EUA) for its COVID-19 vaccine with the Food and Drug Administration. The Vaccines and Related Biological Products Advisory Committee (VRBPAC) is scheduled to meet February 26 to consider the application. Johnson & Johnson, whose product requires only one dose and can be stored with normal refrigeration, demonstrated 66% efficacy against COVID-19 symptoms in trials but 100% efficacy against hospitalization and death. The stated efficacy dropped to 57% against the South African variant.