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January 14, 2021

State Fire Marshal and COVID-19 Walls. We thank Amy Francis of Windsor House for the following article. A representative of the State Fire Marshal's (SFM's) office clarified citations vs. violations in regard to temporary COVID-19 walls. The SFM representative said they understand the walls are needed because of the pandemic and will allow them during the continuing state of emergency. However, the representative stressed that the facility should make both the local fire and building departments aware of the walls. The fire department needs to know what they will encounter if they must respond to a fire at the building. One member voiced concern that their county building department wanted $225 to approve the walls under a temporary permit. The SFM representative felt this fee should not be charged. OHCA recommends that you get approval from your local fire department and also attempt to get building department approval. The SFM representative stated that even with the local approvals, the SFM most likely would list the COVID-19 walls as a non-punitive violation. This means it is on record that the walls exist for the SFM inspector to go back and check in the future. The representative stated that it is not a citation, which would be negligent non-compliance. A true citation would have to be approved by this SFM representative, but even if a citation was issued, he would work with the facility to help them come into compliance. Please let Mandy Smith know if you have any further concerns with this issue.

Long-Term Care COVID-19 Cases Continue Downward Trend. As has been the case for the last four weeks, the Health Department's (ODH's) dashboard of COVID-19 cases in long-term care facilities showed a decline this week. There were 2,711 resident cases and 2,065 staff cases, the lowest levels since the week ending November 12, 2020. Mortality edged up slightly, from 203 deaths last week to 206 this week. In the general population, today's case number was 7,654, about 300 higher than the three-week average. Hamilton County turned purple in the refresh of the Ohio Public Health Advisory System.

SNF Vaccinations in Ohio. In his remarks today, Governor Mike DeWine discussed COVID-19 vaccinations in SNFs through the Pharmacy Partnership for Long-Term Care, providing statistics on first-round completion by each of the participating pharmacies. According to the Governor, as of yesterday, Absolute had completed all of their first-round clinics, CVS 97%, Pharmscript 97%, and Walgreens 95%. As the first facilities received their second clinics this week, members anecdotally reported some increased uptake among staff, but typically not a significant amount. For instance, one member said their staff vaccination percentage rose from 40% to 55%.

COVID-19 Phase 1B Vaccinations. At yesterday's meeting of the COVID-19 Vaccination Providers Workgroup, ODH's Lance Himes explained the state's plans for Phase 1B of the vaccine roll-out. Please see his slides as well as this ODH guidance for detailed information. Mr. Himes also touched on a key issue relative to Phase 1A, as one of the slides states, "[f]urther guidance is being developed for prioritization of Phase 1A recipients who initially declined the vaccine but might later decide to be vaccinated." A considerable number of facility staff members fall into this group.

ODM Opens Portal for Visitation Grants. The Department of Medicaid (ODM) today announced a portal by which SNFs can apply for civil money penalty-funded grants to cover up to $3,000 of expenses to facilitate visitation. The center must have incurred the expenses since September 17, 2020, which is when the Centers for Medicare and Medicaid Services (CMS) published Quality, Safety, and Oversight letter (QSO) 20-39 that authorized the grants. The only allowable expenses are for tents or other shelters for outdoor visitation or for plexiglass dividers. The opening page of the portal has a long list of non-allowable expenses. ODM designed the portal to make the application and approval process much easier than it was for the electronic communication equipment grants. You may enter applications for more than one facility in one session. For questions, please email

ODM Communication Grant Update. Speaking of the "Ipad" grants, ODM's Amy Hogan informed us that although the agency approved 764 SNFs to receive grants, many have not submitted receipts necessary to process payment. About a week ago, ODM emailed a second approval letter to those centers because they may have sent the original notices encrypted and the providers may not have seen them. If you applied for this grant and have not yet submitted receipts, please do so if you are still interested in receiving payment.

TB Testing and COVID-19 Vaccine, Redux. In Tuesday's COVID-19 Update, we reported that ODH addressed the interplay between administration of COVID-19 vaccines and tuberculosis (TB) tests in the context of ICF/IID surveys. Members subsequently asked whether this same logic applies to SNFs and assisted living communities. Although ODH did not speak directly to those facility types, their response could be read as generic to TB testing requirements:

Q. New Hires & TB Testing: The CDC has guidance on TB testing and vaccinations. If we have a new hire who has already received one dose of the vaccine, is it ok to wait to do the TB testing, per the CDC Guidance?

A. Yes, we would recommend a TB symptom screen if they were vaccinated prior to hire. This needs to be addressed in the policies and procedures, that facilities will do a symptom screen in these circumstances and then provide the TB test after 4 weeks. 

CMS Comments on QSO-21-07 for ICFs/IID. On a call today with CMS, OHCA asked if they consider the guidance to ICF/IIDs in the frequently-asked-questions (FAQ) section of QSO-21-07 (released December 17, 2020) regulation or if it is simply recommendations. CMS’s Don Howard said CMS informed state survey agencies that the FAQs are strictly guidance and not regulations or mandates. Mr. Howard added that ICF providers should try to follow the guidance, but in cases where they are unable to meet the recommendations, they should communicate why they can’t implement them. Mr. Howard understood that individuals may have varying abilities to comply with COVID-19 precautions and said ICF providers should implement the least restrictive interventions possible for each individual served. 

Anthem Extends SNF PA Waiver Through January 31. Joining the majority of health plans in the state, Anthem BlueCross BlueShield of Ohio (Anthem) announced yesterday the extension of prior authorization (PA) waivers for SNF admissions through January 31, 2021. The current waiver, which was slated to end tomorrow, applies to commercial and Medicare Advantage plan beneficiaries admitted to an in-network center. Notification of admission is still required, with medical records, on day two of admission. Anthem also reserves the right to audit patient transfers at a later date. OHCA updated our SNF Prior Authorization Waiver Grid to reflect this change.

Grants for Families of Health Care Workers. OHCA learned of an opportunity for families who have lost a health care worker due to COVID-19 to apply for grants through the Brave of Heart Fund. The fund is a combined effort of both New York Life and Cigna through their foundations. According to the website, “[t]he cash grant awards will provide basic and continuing financial support for common needs, such as funeral costs, medical care, counselling, food, educational expenses of children and other dependents currently in school, mortgage or rent payments, and immediate living expenses, as these family members manage the impact of the COVID-19 crisis and begin to move forward.” Applications are being accepted through May 15, 2021. Since this opportunity is not well known, please share this information with families who may be eligible.