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January 11, 2021

CMS County-Level Positivity Numbers. The Centers for Medicare and Medicaid Services (CMS) posted their weekly update to county-level positivity numbers that apply to SNF testing frequency and visitation. The new Ohio table shows 55 counties red and 33 yellow. According to CMS guidelines, SNFs in these counties must allow in-person visitation (in addition to compassionate care visits) and are required to test staff once a week, except for Athens County, which was red last week and must continue to test twice a week. According to state guidelines, even the yellow counties must test staff twice a week, but as we reported last week, the Health Department's (ODH's) survey branch announced that they would not enforce the state guidelines to the extent that they conflict with the federal.

What You Should Know: Economic Impact Payments and Representative Payees (from AHCA/NCAL). Millions of Americans are slated to receive a second Economic Impact Payment (EIP) as part of the recently passed and enacted Coronavirus bill. This follows the EIP that was distributed in 2020 as part of the response to the COVID-19 pandemic under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. These payments aim to support Americans and provide some financial relief.

It is important to note that CARES Act EIP requirements also apply to the EIPs in the most recent stimulus package, as well as any future payments. If you or someone you know serves as a representative payee for a Social Security or Supplemental Security Income (SSI) beneficiary, that designee is only responsible for managing Social Security or SSI benefits. The EIP is not an SSA benefit, and it belongs to the beneficiary. Representative payees should discuss the payment with the beneficiary, when possible. If the beneficiary requests access to the funds, they’re obligated to provide it.

Learn more about EIPs, including how they’re being delivered to people with representative payees, at the Consumer Financial Protection Bureau site. You can also learn more about these payments from the Internal Revenue Service (IRS). AHCA/NCAL also recorded a webinar in 2020 focused on EIPs from the IRS and important facts for skilled nursing facilities, ICFs/IID, and assisted living centers to know on the use of them. A variety of resources from the Social Security Administration to the National Center on Elder Law and Rights are available at the end of the webinar. Please contact with any questions. 

Public Health Emergency Extended. US Secretary of Health and Human Services Alex Azar extended the national Public Health Emergency (PHE) that was set to expire January 21. Each PHE extension is 90 days from the end of the previous one, so the emergency now will stay in place at least until April 21, 2021. The PHE is important for long-term services and supports providers because of the many special waivers and other provisions that are tied to its existence. Most notable are the three-day stay and spell-of-illness waivers and the federal nurse aide training waiver that apply to SNFs, but there are a number of regulatory waivers, along with telehealth and other reimbursement flexibilities, that are co-extensive with the PHE. In addition, the 6.2% enhanced Federal Medical Assistance Percentage, which greatly benefits Ohio's Medicaid program, continues through the end of the quarter in which the PHE expires (that is, through June 30, 2021).

State Vaccine Round Table Recordings. A number of members asked if the virtual round tables the state held last week for facility staff to address their questions and concerns about the COVID-19 vaccine were recorded. They were recorded, and the recordings now are available. Please go to the Department of Aging vaccine page and scroll down to "Roundtable Discussions," which opens up to links to all nine sessions. Also available from the state is ODH's vaccine communication toolkit, which is frequently updated and contains a variety of materials for educating about the vaccine.

ODH Phase 1B Materials. ODH circulated materials from Friday's webinar for vaccine providers on Phase 1B of the vaccine distribution, which applies to people in the community who are 65 and over or who have developmental disabilities or other congenital conditions. These individuals include people served in their homes by hospice, home care, and ID/DD waiver members. The materials include the slides presented by ODH's Lance Himes and a flyer asking health care professionals to volunteer for the Medical Reserve Corps.

Medicaid Cost Report Extension. Both OHCA and LeadingAge Ohio asked the Department of Medicaid (ODM) to extend the deadline for the 2020 SNF cost report because of COVID-19 and the reporting obligations under the Provider Relief Fund, which will consume many of the same staff and consultants. ODM's Joan Schlageck responded today that the department will allow what amounts to a 15-day extension. She wrote, "[g]iven the timing needed for July 1 ratesetting, ODM will move the Medicaid cost report submission deadline to April 30, 2020 [sic, obviously 2021]. However, with that change in the deadline, no extensions will be granted beyond the April 30, 2020 [sic] deadline. This deadline (and the no extension policy) will be included in the cost report instructions when they are released." As we reported earlier, AHCA/NCAL believes that the PRF reporting deadline (currently February 15, 2021) will be pushed to at least sometime this spring.

Detailed CDC Guidance on N95s. We are somewhat red-faced to admit that highly pertinent Centers for Disease Control and Prevention (CDC) guidance entitled, "Implementing Filtering Facepiece Respirator (FFR) Reuse, Including Reuse after Decontamination, When There Are Known Shortages of N95 Respirators," slipped by us when it was updated on October 19, 2020. This guidance lists strategies for contingency and crisis capacities for N95s and gives an explanation and flow chart for determining whether crisis capacity exists, emphasizing frequent (daily) supply-chain checks.

CDC also distinguishes between extended use of N95s (a strategy to be used to avoid getting to crisis capacity) and limited reuse (a strategy to employ when in crisis capacity). Under limited reuse, the guidance addresses the 5-donnings recommendation:

CDC recommends limiting the number of donnings for an N95 FFR to no more than five per device. It may be possible to don some models of FFRs more than five times. One study reported that fit performance decreased over multiple, consecutive donnings and fit varied among the different models of FFRs examined. If manufacturer guidance on how many times a particular FFR can be donned is not available, the CDC recommends limiting the number of uses to no more than five per device based on published data on changes in FFR fit from a limited number of FFR models over multiple donnings.

(Footnotes omitted.)
CDC extensively discusses self-contamination and decontamination of N95s, noting in a headline that, "N95 FFR decontamination will not increase the number of times or hours that an FFR can be worn." Toward the end of the document, CDC describes the 2012 study on which the 5-donning recommendation is based and concludes by explaining how a facility can move out of crisis capacity. This includes powered air-purifying respirators and elastomeric respirators, which are not practical for use in long-term care.

Although not specific to SNFs, we recommend SNF members review this guidance because it treats in detail relevant topics that are covered more briefly in other guidelines. Please also know that OHCA continues to question ODH's tendency to apply CDC guidance as if it was a rule instead of recommendations for providers to consider, along with other factors, in designing their infection control and prevention policies.