New CMS County-Level Positivity. Today, the Centers for Medicare and Medicaid Services (CMS) issued new county-level positivity data that apply to visitation and staff testing in SNFs. As was the case for the past several weeks, the Ohio table shows further improvement in the positivity numbers. Two more counties went green: Madison and Meigs. In addition, Ashtabula, Champaign, Clark, Columbiana, Coshocton, Crawford, Defiance, Delaware, Fulton, Hancock, Pickaway, Sandusky, Scioto, and Trumbull Counties all moved from red to yellow. The number of red counties is down to 34, although they still include most of the state's major metropolitan counties. SNFs in green and yellow counties now must allow indoor visitation unless there has been a new, facility-onset COVID-19 case in the facility in the last 14 days. As discussed in last Thursday's COVID-19 Update ("SNF Testing Controversy"), SNFs in counties that are yellow or green for 14 days and that are not in outbreak can consider the impact of the color change on their staff testing frequency.
New State-Supported Testing Schedule Out. The Health Department (ODH) announced via Enhanced Information Dissemination and Collection system (EIDC) notice this morning that the new long-term care testing schedule is out. It covers the period February 15 to March 12, 2021, and includes both assisted living communities and SNFs. Interestingly, contrary to the state guidelines for SNFs (see slide 15), the schedule appears to provide state support for opt-in centers only once a week (two polymerase chain reaction (PCR) and two antigen rounds per month). The same support applies to opt-in assisted living communities. We will check to make sure this is accurate.
The EIDC notice specifies:
The upcoming test schedule for February 15, 2021 through March 12, 2021 is available by viewing https://testingschedule.age.ohio.gov, including lab assignments as they may have changed.
Supplies will begin shipping the week of February 8, 2021.
Please make sure that our COVIDTesting@age.ohio.gov is a part of your safe sender's list/address book/saved contacts to ensure you receive important testing communications.
Continue to visit our website to obtain testing resources or feel free to reach out to COVIDTesting@age.ohio.gov with questions.
Please also note that the portal for self-insured providers' reimbursement is still down.
CDC Guidance on Third Clinics. Today, AHCA/NCAL shared a set of frequently-asked questions from CDC relating to third clinics under the Pharmacy Partnership for Long-Term Care. Unfortunately, CDC answers a question about first doses on the third clinic this way:
Q: If LTCF residents and staff have not received a first dose of COVID-19 vaccine, should they receive their first dose at the third and final clinic scheduled as part of the Pharmacy Partnership for Long-Term Care Program?
The Centers for Disease Control and Prevention (CDC) supports optimizing vaccine access for all LTCF staff and residents. However, some jurisdictions have asked pharmacy partners not to initiate first dose vaccinations at third clinics. In this case, LTCFs and pharmacy partners should follow jurisdictional guidance.
CDC, however, then goes on to discuss how people who receive the first dose at the third clinic could get the second dose, broken into two questions, one on Moderna and one on Pfizer/BioNTech. After listing options for getting the second dose of Pfizer vaccine, CDC writes, "[i]f all potential options for administering a second dose of Pfizer-BioNTech vaccine have been exhausted, LTCF clinical leadership may consider counseling residents to finish the vaccine series using the Moderna vaccine." CDC quotes Advisory Committee on Immunization Practices guidance on this point. This recommendation could provide a pathway to addressing the state's concerns about availability of Pfizer after the third clinic.
Last, CDC addresses vaccinations for facility residents and staff who do not get them during the clinics, suggesting that providers reach out to their long-term care pharmacies. The pharmacies will need to enroll as vaccine providers either with the Federal Retail Pharmacy Program, which kicks off February 11, or with the state. CDC concludes that they "will provide more detailed guidance in the coming weeks on next steps for COVID-19 vaccination in LTCFs after the federal Pharmacy Partnership for LTC Program concludes."
BWC Hosts Webinar on Air Quality Improvement Grant. The Bureau of Workers Compensation (BWC) and the Facilities Construction Commission (OFCC) are hosting a webinar at 10:00 a.m. on Thursday, February 18, entitled, "Reducing COVID-19 Transmissions Through HVAC Improvements." In addition to discussing ways to assess and to manage indoor air quality to reduce COVID-19 transmission risks, the webinar also will cover BWC's COVID-19 Air Quality Assistance Program. This program provides up to $15,000 in funding to licensed SNFs, residential care facilities (assisted living), adult day centers, and adult day support providers to help cover the costs of inspections, assessments, maintenance, and improvements to indoor heating, ventilation, and air conditioning (HVAC) systems to control the spread of COVID-19. It also provides reimbursement for secondary devices designed to destroy bacteria, mold, and viruses. Of the $28 million in federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funding earmarked for this program, BWC has received around 700 applications totaling $7.6 million. We encourage members to participate in the webinar to learn more about the funding program and ways to improve air quality in their facilities. Details about the February 18 webinar can be found here.
Vaccinations Now Available to People 65+. Under the state's Phase 1B vaccine distribution plan, today marks the beginning of eligiblity for individuals aged 65 to 69. ODH's tool for finding vaccine providers is at this link. Next week, people with certain congenital conditions will be rolled in, which will be the last Phase 1B population group. The state has not made any announcements about who is next.
NHSN Reporting Changes, Webinars. The National Healthcare Safety Network (NHSN) recently made a number of changes to its COVID-19 reporting system for long-term care facilities. AHCA/NCAL described these changes as follows:
Last week, NHSN emailed its users to notify them of updates made to the Long-Term Care Facility COVID-19 Module. Below is a brief summary of the updates that were made.
- COVID-19 Point of Care Test Reporting Tool – This is an optional reporting component if your facility is reporting to state/local authorities. If your facility is not reporting to state/local authorities, then you are required to report to the COVID-19 Point of Care Test Reporting Tool to meet the requirements of reporting.
- COVID-19 Resident Impact and Facility Capacity Pathway – This is a required pathway, as it always has been, but updates were made to this pathway. There is now a question in this pathway that asks about vaccination status for residents newly positive for COVID-19.
- COVID-19 Therapeutics [monoclonal antibodies] Module – This is a new optional reporting module. However, the information gathered from this module helps inform decision making processes.
- COVID-19 Vaccination Data Modules – This is an optional reporting module. However, the information gathered from this module helps inform decision making processes.
For more guidance on each of these, please refer to the NHSN LTCF COVID-Module website. AHCA/NCAL continues to recommend that facilities undertake the voluntary, weekly reporting of aggregate vaccination data to NHSN. According to AHCA/NCAL, the data that the pharmacies in the Pharmacy Partnership for Long-Term Care report to the states is inadequate for analysis purposes, so they need the more targeted NHSN data.
NHSN also is offering training webinars on the reporting modules, including the changes noted above, this Thursday, February 11, from 2:00-3:00 p.m. and Friday, February 12, from 1:00-2:00 p.m. The content both days is the same, and you can register for either session using this link.
IPRO Notice on CMS Infection Control Training. Members reported last Friday that IPRO sent them another email notice about CMS's infection control training program. The notice states, "CMS is strongly encouraging all facilities to complete CMS Targeted COVID-19 Training for Frontline Nursing Home Staff & Management. The expectation is that 75% of staff complete the training. Completion rates by each center is being monitored by CMS." While we are not in any way denigrating the CMS training or IPRO's role in promoting it, members had some questions that we would like to address. First, this CMS training is not the same as the Agency for Healthcare Quality and Research-sponsored Project ECHO training that OHCA, together with partner organizations, is delivering. Second, the CMS training is not mandatory. Third, CMS indeed has monitored participation. In November, they published a list of SNFs that had 50% or higher completion rates.